Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial

P. Verschueren; D. de Cock; L. Corluy; R. Joos; C. Langenaken; V. Taelman; F. Raeman; I. Ravelingien; K. Vandevyvere; J. Lenaerts; E. Geens; P. Geusens; J. Vanhoof; A. Durnez; J. Remans; B. vander Cruyssen; E. van Essche; A. Sileghem; G. de Brabanter; J. Joly; K. van der Elst; S. Meyfroidt; R. Westhovens; the CareRA study group

doi:10.1186/s13075-015-0611-8

Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial

P. Verschueren^*, D. de Cock, L. Corluy, R. Joos, C. Langenaken, V. Taelman, F. Raeman, I. Ravelingien, K. Vandevyvere, J. Lenaerts, E. Geens, P. Geusens, J. Vanhoof, A. Durnez, J. Remans, B. vander Cruyssen, E. van Essche, A. Sileghem, G. de Brabanter, J. JolyK. van der Elst, S. Meyfroidt, R. Westhovens, the CareRA study group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: Considering a lack of efficacy data in patients with early rheumatoid arthritis (eRA) presenting without classical markers of poor prognosis, we compared methotrexate (MTX) with or without step-down glucocorticoids in the CareRA trial.

Methods: Disease-modifying antirheumatic drug-naive patients with eRA were stratified into a low-risk group based on prognostic markers that included non-erosiveness, anti-citrullinated protein antibodies and rheumatoid factor negativity and low disease activity (Disease Activity Score in 28 joints based on C-reactive protein (DAS28(CRP))

Results: We analyzed 43 COBRA Slim and 47 MTX-TSU patients and found that 65.1% in the COBRA Slim group and 46.8% in the MTX-TSU group reached remission (P = 0.081). Mean +/- standard deviation area under the curve values of DAS28(CRP) were 13.84 +/- 4.58 and 11.18 +/- 4.25 for the MTX-TSU and COBRA Slim patients, respectively (P = 0.006). More COBRA Slim patients had an HAQ score of 0 (51.2% versus 23.4%, P = 0.006) at week 16. Therapy-related AEs between groups did not differ.

Conclusion: In patients with low-risk eRA, MTX with step-down glucocorticoid bridging seems more efficacious than MTX step-up monotherapy, with a comparable number of AEs observed over the first 16 treatment weeks.

Original language	English
Article number	97
Number of pages	7
Journal	Arthritis Research & Therapy
Volume	17
Issue number	1
Early online date	9 Apr 2015
DOIs	https://doi.org/10.1186/s13075-015-0611-8
Publication status	Published - 9 Apr 2015

Keywords

COMBINATION-TREATMENT STRATEGIES
MODIFYING ANTIRHEUMATIC DRUGS
TIGHT CONTROL
EULAR RECOMMENDATIONS
AMERICAN-COLLEGE
FOLLOW-UP
MANAGEMENT
THERAPY
REMISSION
CLASSIFICATION

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Verschueren, P., de Cock, D., Corluy, L., Joos, R., Langenaken, C., Taelman, V., Raeman, F., Ravelingien, I., Vandevyvere, K., Lenaerts, J., Geens, E., Geusens, P., Vanhoof, J., Durnez, A., Remans, J., vander Cruyssen, B., van Essche, E., Sileghem, A., de Brabanter, G., ... CareRA study group, T. (2015). Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial. Arthritis Research & Therapy, 17(1), Article 97. https://doi.org/10.1186/s13075-015-0611-8

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title = "Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial",

abstract = "Introduction: Considering a lack of efficacy data in patients with early rheumatoid arthritis (eRA) presenting without classical markers of poor prognosis, we compared methotrexate (MTX) with or without step-down glucocorticoids in the CareRA trial.Methods: Disease-modifying antirheumatic drug-naive patients with eRA were stratified into a low-risk group based on prognostic markers that included non-erosiveness, anti-citrullinated protein antibodies and rheumatoid factor negativity and low disease activity (Disease Activity Score in 28 joints based on C-reactive protein (DAS28(CRP))Results: We analyzed 43 COBRA Slim and 47 MTX-TSU patients and found that 65.1% in the COBRA Slim group and 46.8% in the MTX-TSU group reached remission (P = 0.081). Mean +/- standard deviation area under the curve values of DAS28(CRP) were 13.84 +/- 4.58 and 11.18 +/- 4.25 for the MTX-TSU and COBRA Slim patients, respectively (P = 0.006). More COBRA Slim patients had an HAQ score of 0 (51.2% versus 23.4%, P = 0.006) at week 16. Therapy-related AEs between groups did not differ.Conclusion: In patients with low-risk eRA, MTX with step-down glucocorticoid bridging seems more efficacious than MTX step-up monotherapy, with a comparable number of AEs observed over the first 16 treatment weeks.",

keywords = "COMBINATION-TREATMENT STRATEGIES, MODIFYING ANTIRHEUMATIC DRUGS, TIGHT CONTROL, EULAR RECOMMENDATIONS, AMERICAN-COLLEGE, FOLLOW-UP, MANAGEMENT, THERAPY, REMISSION, CLASSIFICATION",

author = "P. Verschueren and {de Cock}, D. and L. Corluy and R. Joos and C. Langenaken and V. Taelman and F. Raeman and I. Ravelingien and K. Vandevyvere and J. Lenaerts and E. Geens and P. Geusens and J. Vanhoof and A. Durnez and J. Remans and {vander Cruyssen}, B. and {van Essche}, E. and A. Sileghem and {de Brabanter}, G. and J. Joly and {van der Elst}, K. and S. Meyfroidt and R. Westhovens and {CareRA study group}, the",

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Verschueren, P, de Cock, D, Corluy, L, Joos, R, Langenaken, C, Taelman, V, Raeman, F, Ravelingien, I, Vandevyvere, K, Lenaerts, J, Geens, E, Geusens, P, Vanhoof, J, Durnez, A, Remans, J, vander Cruyssen, B, van Essche, E, Sileghem, A, de Brabanter, G, Joly, J, van der Elst, K, Meyfroidt, S, Westhovens, R & CareRA study group, T 2015, 'Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial', Arthritis Research & Therapy, vol. 17, no. 1, 97. https://doi.org/10.1186/s13075-015-0611-8

Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial. / Verschueren, P.; de Cock, D.; Corluy, L. et al.
In: Arthritis Research & Therapy, Vol. 17, No. 1, 97, 09.04.2015.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial

AU - Verschueren, P.

AU - de Cock, D.

AU - Corluy, L.

AU - Joos, R.

AU - Langenaken, C.

AU - Taelman, V.

AU - Raeman, F.

AU - Ravelingien, I.

AU - Vandevyvere, K.

AU - Lenaerts, J.

AU - Geens, E.

AU - Geusens, P.

AU - Vanhoof, J.

AU - Durnez, A.

AU - Remans, J.

AU - vander Cruyssen, B.

AU - van Essche, E.

AU - Sileghem, A.

AU - de Brabanter, G.

AU - Joly, J.

AU - van der Elst, K.

AU - Meyfroidt, S.

AU - Westhovens, R.

AU - CareRA study group, the

PY - 2015/4/9

Y1 - 2015/4/9

N2 - Introduction: Considering a lack of efficacy data in patients with early rheumatoid arthritis (eRA) presenting without classical markers of poor prognosis, we compared methotrexate (MTX) with or without step-down glucocorticoids in the CareRA trial.Methods: Disease-modifying antirheumatic drug-naive patients with eRA were stratified into a low-risk group based on prognostic markers that included non-erosiveness, anti-citrullinated protein antibodies and rheumatoid factor negativity and low disease activity (Disease Activity Score in 28 joints based on C-reactive protein (DAS28(CRP))Results: We analyzed 43 COBRA Slim and 47 MTX-TSU patients and found that 65.1% in the COBRA Slim group and 46.8% in the MTX-TSU group reached remission (P = 0.081). Mean +/- standard deviation area under the curve values of DAS28(CRP) were 13.84 +/- 4.58 and 11.18 +/- 4.25 for the MTX-TSU and COBRA Slim patients, respectively (P = 0.006). More COBRA Slim patients had an HAQ score of 0 (51.2% versus 23.4%, P = 0.006) at week 16. Therapy-related AEs between groups did not differ.Conclusion: In patients with low-risk eRA, MTX with step-down glucocorticoid bridging seems more efficacious than MTX step-up monotherapy, with a comparable number of AEs observed over the first 16 treatment weeks.

AB - Introduction: Considering a lack of efficacy data in patients with early rheumatoid arthritis (eRA) presenting without classical markers of poor prognosis, we compared methotrexate (MTX) with or without step-down glucocorticoids in the CareRA trial.Methods: Disease-modifying antirheumatic drug-naive patients with eRA were stratified into a low-risk group based on prognostic markers that included non-erosiveness, anti-citrullinated protein antibodies and rheumatoid factor negativity and low disease activity (Disease Activity Score in 28 joints based on C-reactive protein (DAS28(CRP))Results: We analyzed 43 COBRA Slim and 47 MTX-TSU patients and found that 65.1% in the COBRA Slim group and 46.8% in the MTX-TSU group reached remission (P = 0.081). Mean +/- standard deviation area under the curve values of DAS28(CRP) were 13.84 +/- 4.58 and 11.18 +/- 4.25 for the MTX-TSU and COBRA Slim patients, respectively (P = 0.006). More COBRA Slim patients had an HAQ score of 0 (51.2% versus 23.4%, P = 0.006) at week 16. Therapy-related AEs between groups did not differ.Conclusion: In patients with low-risk eRA, MTX with step-down glucocorticoid bridging seems more efficacious than MTX step-up monotherapy, with a comparable number of AEs observed over the first 16 treatment weeks.

KW - COMBINATION-TREATMENT STRATEGIES

KW - MODIFYING ANTIRHEUMATIC DRUGS

KW - TIGHT CONTROL

KW - EULAR RECOMMENDATIONS

KW - AMERICAN-COLLEGE

KW - FOLLOW-UP

KW - MANAGEMENT

KW - THERAPY

KW - REMISSION

KW - CLASSIFICATION

U2 - 10.1186/s13075-015-0611-8

DO - 10.1186/s13075-015-0611-8

M3 - Article

C2 - 25889222

SN - 1478-6354

VL - 17

JO - Arthritis Research & Therapy

JF - Arthritis Research & Therapy

IS - 1

M1 - 97

ER -

Verschueren P, de Cock D, Corluy L, Joos R, Langenaken C, Taelman V et al. Patients lacking classical poor prognostic markers might also benefit from a step-down glucocorticoid bridging scheme in early rheumatoid arthritis: week 16 results from the randomized multicenter CareRA trial. Arthritis Research & Therapy. 2015 Apr 9;17(1):97. Epub 2015 Apr 9. doi: 10.1186/s13075-015-0611-8