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 journalArticleAcademicpeer-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 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

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