News from EULAR 2008, the Annual European
Congress of Rheumatology
Taken from NRAS magazine, Autumn 2008
The wording of this information can often be somewhat technical, and although we do our best to simplify it, this is not always very easy! In the event that there is anything you do not understand and feel it may be important to you to know more, please contact us.
Drug free remission shown in one in five
Half of patients with early rheumatoid arthritis treated with the anti-tumour necrosis factor inhibitor (anti-TNF) infliximab plus methotrexate achieve remission, and up to one in five achieve drug-free remission, according to five-year follow-up results from the Dutch BeSt study.
The study involved 508 patients with recent-onset rheumatoid arthritis and the patients were monitored intensively and their treatment adjusted to keep their disease activity score (DAS) low (i.e. below 2.4).
Dr Andrew Östör, consultant rheumatologist at Addenbrooke’s Hospital, Cambridge commented: “Patients with aggressive early rheumatoid arthritis potentially do better when treated with initial combination therapy including a biologic…. Early improvement is important for patients’ confidence in their treatment.” He added: “Continuous monitoring and tight disease control – based on DAS score – is important in optimising therapy for individual patients.”
Adding an anti-TNF better than adding DMARDs in RA patients failing on methotrexate
Adding an anti-TNF (infliximab) achieves significantly better response than adding the conventional disease modifying antirheumatic drugs (DMARDs) sulfasalazine plus hydroxychloroquine in patients with early rheumatoid arthritis failing initial methotrexate monotherapy, a Swedish study has shown.
New efficacy data on HUMIRA
New data from a series of trials have shown that 42 per cent of patients achieved sustained remission within a year and-a-half of continued combination therapy with HUMIRA plus methotrexate (MTX). In addition, t he number of patients achieving clinical remission continued to increase after 2 or more years of ongoing treatment. Clinical remission is defined by an absence of signs of inflammation, as well as reduced morning stiffness, freedom from fatigue, joint pain and soft tissue swelling.
The data was from a combined analysis of five separate studies in people with long-standing RA. Over 1,450 patients were enrolled in the studies. Research to measure patients’ continued response to the combination of treatment was carried out over a period of seven years.
HUMIRA, an anti-TNF therapy was recommended by NICE for the treatment of rheumatoid arthritis in 2007. Recent research carried out on anti-TNFs showed that these treatments were also associated with improved capacity for work, increased gainful employment and reduced time off work.
Study indicates the value of a six-month trial of anti-TNFs
More than half of RA patients on anti-TNF therapy who fail to meet EULAR response criteria after three months of treatment, go on to achieve a response at six months, according to researchers at Addenbrooke’s Hospital, Cambridge.
Different guidelines currently have conflicting recommendations on how long to treat with an anti-TNF before determining whether or not a patient has responded and treatment is worth continuing. NICE recommends continuation if a response is achieved by six months, but British Society for Rheumatology guidance states that non-response at three months warrants re-evaluation of treatment. EULAR and ACR both maintain a three-month cut-off.
The results for 194 patients who had DAS responses recorded at three months showed that 83% had met the response criteria at this time point, while 33 patients (17%) had not. Of these 33 patients, 20 continued with anti-TNF therapy and responses were available for 15 of them at six months. Just over half (53%) of them achieved a EULAR response, with none requiring an increase in dose to reach this.
Early treatment with biologic treatments prevents radiological progression
Early treatment with infliximab, as part of intensive combination therapy, achieves higher rates of remission and prevents radiological progression, a Finnish study revealed.
The NEO-RACO Study included 100 patients with early, active RA. They were started on combination therapy with three DMARDs (methotrexate, sulfasalazine and hydrochloroquine) plus prednisolone – a regimen the researchers call the FIN-RACo strategy, which has previously been shown to achieve early remission in 37% of patients. The patients were also randomised to infliximab or placebo, to see if the anti-TNF increased remission rates further.
Results showed significantly more patients treated with infliximab achieved remission after two years. More than two-thirds (70%) were in remission, compared to just over half (53%) of those treated with the FIN-RACo regimen. Remission rate over time was nearly twice as high with infliximab. Sustained remission was achieved in 31% of the FIN-RACo group, and 40% of the patients also treated with infliximab.
Radiological progression was also better with the infliximab combination. Just over half (54%) had a Sharp/van der Heijde score (SHS) – a measure of joint damage on X-ray - of 0 at two years, compared to 41% of patients treated with the FIN-RACo. The mean change of SHS over the two years was 1.4 in patients treated with FIN-RACo, compared to -0.2 in those also treated with infliximab.
The research group, led by M. Leirisalo-Repo, from Helsinki University Central Hospital, Helsinki, Finland, said: “Adding infliximab to intensive use of FIN-RACo in early active RA during the first six months reflected in higher frequencies of remissions over time and prevented radiological progression during two years.”
Anti TNF therapy can prevent bone loss in RA
In contrast to the progressive bone loss observed after conventional disease modifying anti rheumatic drug therapy, work on adalimumab from Holland and infliximab from Finland suggests anti TNF treatments may result in an arrest of general bone loss.