Treating to Target Reduces Rheumatoid Arthritis Mortality

Adjusting treatment to maintain tight control of disease-related disability reduces mortality in rheumatoid arthritis, according to new research presented here at the 2014 annual meeting of the American College of Rheumatology.

In the study, maintenance of a Disease Activity Score (DAS) of 2.4 or lower over 10 years was associated with a reduction in mortality rate among RA patients to a level insignificantly different from that of the general population.

“Recent studies have shown diverging results about mortality trends in patients with rheumatoid arthritis,” according to lead study author Cornelia Allaart, MD, of the Leiden University Medical Center. Mortality rates in those with RA are higher than in the general population, with a recent large European study indicating an increase of 20% related to RA. “Our aim was to determine survival after 10 years of treat-to-target therapy in patients with early RA,” as well as to define risk factors for mortality.

The study, conducted in The Netherlands, enrolled 508 Dutch patients with recent-onset RA. They were randomized to one of four treatment arms: sequential monotherapy beginning with methotrexate, step-up therapy beginning with methotrexate, or initial combination therapy of methotrexate plus infliximab or prednisone/sulfasalazine.

Patients were assessed for DAS score every 3 months, and medications were adjusted to keep the score at or below the target of 2.4. Those scoring above the target advanced to the next medication or step in their protocol, while those at or below the target for at least 6 months had their medications reduced, tapering first to monotherapy and then, after an additional 6 months of successful treatment, to no treatment.

Over the course of the study, approximately 80% of patients achieved the low disease activity target, 45% were classified as in remission, and 15% as in drug-free remission.

Seventy-two patients died over the 10-year study. There was no difference in survival based on treatment arm. Based on age, sex, and other demographic factors, the comparable mortality in the general Dutch population would have been 62 individuals, Allaart said, a result not significantly different from the 72 deaths observed.

“After 10 years of continued tight controlled treatment in patients with rheumatooid arthritis, the survival rate was comparable to the general Dutch population, without differences in the treatment strategies,” she said. “With earlier treatment and targeted treatment, where medication is intensified until low disease activity is achieved and maintained, inflammation can be so well controlled that it no longer affects survival.”