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

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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 languageEnglish
Article number97
Number of pages7
JournalArthritis Research & Therapy
Volume17
Early online date9 Apr 2015
DOIs
Publication statusPublished - 9 Apr 2015

Keywords

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

Cite this

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, [97]. https://doi.org/10.1186/s13075-015-0611-8