What is the definition of remission in RA

Remission in rheumatoid arthritis • Criteria for clinical remission Remission • Modified ACR criteria

Remission is Heterogenous • Clinical Remission: ACR/DAS criteria, or normal acute phase response, no

Radiographic progression – Improvement with TNF Targeted Therapies (TEMPO) Total sharp score change over

TEMPO extension study: DAS 28 remission ETN + MTX Combination (n=96) 15% MTX add

Be. St Treatment Strategies Sequential monotherapy n=126 Step-up combination n=121 Initial combination with prednisone

Percentage in remission in Be. St % with DAS 44 <1. 6 100 80

Results: Summary · At 5 years – 48% of patients in DAS remission –

Slides: 8

Download presentation

What is the definition of remission in RA? American Rheumatism Association (ARA)¹ • Five or more of the following criteria must be fulfilled for at least two consecutive months: • • • Duration of morning stiffness not exceeding 15 minutes No fatigue No joint pain (by history) No joint tenderness or pain on motion ESR (Westergren method): Female < 30 mm/h, Male < 20 mm/h DAS 44² DAS 28² CDAI³ <1. 6 <2. 6 < 2. 8 1. Pinals RS, et al. Arthritis Rheum. 1981; 24: 1308 -15. 2. Prevoo. Br J Rheumatol. 1996; 35: 1101 -5. 3. Aletaha D, et al Arthritis Res Ther. 2005; 7: R 796 -R 806

Remission in rheumatoid arthritis • Criteria for clinical remission Remission • Modified ACR criteria • DAS 28 • SDAI (SJ+TJ+PGA+CRP) • CDAI (SJ+TJ+PGA) • Sustained remission • Imaging remission 4/5 (pain, TJ, SJ, MS, ESR) ≤ 1. 6 ≤ 2. 6 ≤ 3. 3 ≤ 2. 8 • MRI, US • Complete clinical response (FDA) : remission ≥ 6 months + radiographic arrest LDA ≤ 2. 4 ≤ 3. 2 ≤ 11 ≤ 10

Remission is Heterogenous • Clinical Remission: ACR/DAS criteria, or normal acute phase response, no clinical synovitis • Imaging Remission: no significant synovitis on sensitive imaging • True Remission: a state of no detectable disease with no progression of structural damage

Radiographic progression – Improvement with TNF Targeted Therapies (TEMPO) Total sharp score change over 3 years 6 MTX Change from baseline (mean ± SD) ETN + MTX 4 2 * * * 0 †‡ †‡ †‡ -2 0 van der Heijde, et al. Ann Rheum Dis 2006; 65(Suppl. II): 509 1 Years 2 3 P<0. 05 * ETN vs MTX, † combo vs MTX ‡ combo vs ETN

TEMPO extension study: DAS 28 remission ETN + MTX Combination (n=96) 15% MTX add ETN (n=55) 64% (p<0. 05) 47% 42% 41% 26% ETN add MTX (n=76) 56% (p<0. 05) 40% 25% Martin Mola E et al. Presented at EULAR 2007. FRI 0148.

Be. St Treatment Strategies Sequential monotherapy n=126 Step-up combination n=121 Initial combination with prednisone n=133 Initial combination with infliximab n =128

Percentage in remission in Be. St % with DAS 44 <1. 6 100 80 60 40 20 0 0 3 6 9 12 15 18 Time (months) sequential mono combi with prednisone step-up combination combi with infliximab De Vries – Bouwstra Ann Intern Med 2007; 146: 406 -15. 21 24

Results: Summary · At 5 years – 48% of patients in DAS remission – 10% - 19% of patients in drug-free remission – 51 patients previously in drug-free remission had restarted a DMARD Klarenbeek et al. Ann Rheum Dis 2008; 67(Suppl II): 187