Best to Treat Rheumatoid Arthritis Early and Aggressively for Optimal Outcomes

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Early, intensive treatment of rheumatoid arthritis (RA) has long-term benefits, including a reduction in mortality to rates similar to those in the general population, reported Dutch researchers. They presented the results of their prospective cohort study at the Annual European Congress of Rheumatology (EULAR 2018) on June 13 in Amsterdam, The Netherlands.

“Our results confirm that early, intensive treatment of rheumatoid arthritis, including use of glucocorticoids, has long-term benefits,” said one of the study authors, Professor Maarten Boers, VU University Medical Center, Amsterdam. “Importantly, this study is one of the first to show a normalization of RA mortality compared to the general population after 23 years of follow-up.”

The study looked at mortality after 23 years of follow-up of the COBRA (COmbinatietherapie Bij Rheumatoide Artritis) trial. In the original study, 6 patients with early RA were treated with sulfasalazine (SSZ) monotherapy or a combination of SSZ, low-dose methotrexate, and initially high, step-down prednisolone.

Results demonstrated the combined therapy regimen offered additional disease control over SSZ alone. In 2010, after 11 years of follow-up, another study showed numerically (but not significantly) lower mortality in patients receiving the combined therapy regimen compared with patients receiving SSZ monotherapy.

The current study included data from 154 of the 155 original patients with a mean follow-up time of 23 years. Using a reference sample matched for age and gender, investigators demonstrated numerically (but not significantly) lower mortality of the study participants (44/154, 28%) compared with the general population (55/154, 35%). Within the study population, 20/75 (27%) died who were randomized to the combined therapy regimen, and 24/79 (30%) on SSZ alone. The difference between the two therapeutic approaches was not significant, and the positive trend for combined therapy over SSZ decreased over time.

References:

Poppelaars PBM, van Tuyl LHD, Boers M. Mortality of the COBRA early rheumatoid arthritis trial cohort after 23 years follow up. Presented at: EULAR 2018; 13-16 June 2018; Amsterdam, The Netherlands. Abstract OP0015.