Active Conventional Therapy Linked to High, Early Remission Rates in Rheumatoid Arthritis

The efficacy of active conventional therapy in early rheumatoid arthritis was examined.

The following article is a part of conference coverage from the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the EULAR 2020 E-Congress.


Methotrexate (MTX) combined with glucocorticoids or biologic treatments effectively reduces disease activity in patients with early, drug-naive rheumatoid arthritis (RA), according to study results presented at the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020.

The NORD-STAR study ( Identifier: NCT01491815) is a multicenter, randomized clinical trial of patients residing in Nordic countries and the Netherlands. Adult patients with early RA and no prior treatment exposure were randomly assigned 1:1:1:1 to receive MTX combined with active conventional therapy (ACT); subcutaneous certolizumab (CZP) 200 mg every other week; subcutaneous abatacept (ABA) 125 mg every week; or subcutaneous tocilizumab (TCZ) 162 mg every week. Patients randomly assigned to ACT either received oral prednisolone tapered quickly (arm 1A) or sulphasalazine with hydroxychloroquine and intra-articular glucocorticoid injections in swollen joints (arm 1B).

The primary outcome was disease remission, defined as a clinical disease activity index (CDAI) ≤2.8 at week 24. Adjusted logistic regression was used to assess the relative performance of each treatment arm. Noninferiority analyses used a margin of 15%.

The study cohort included 812 patients, among whom 31.2% were men. Mean age at randomization was 54.3±14.7 years. CDAI remission was achieved by 42.0%, 47.8%, 52.5%, and 41.0% of patients in the ACT, CZP, ABA, and TCZ arms, respectively. ABA outperformed ACT, with an adjusted remission rate difference of 9% (95% CI, 0.1%-19%), favoring ABA. The CZP (+4%; -5% to 13%) and TCZ (-1%; -10% to 9%) arms displayed comparable remission rates to ACT.

These data suggest that conventional therapy has comparable efficacy to certain biologics in the treatment of early RA. High remission rates were observed across all study arms, though ABA combined with MTX was associated with greatest symptom improvement.  

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Hetland ML, Haavardsholm EA, Rudin A, et al. A multicenter randomized study in early rheumatoid arthritis to compare active conventional therapy versus three biological treatments: 24 week efficacy results of the NORD-STAR trial. Presented at: EULAR 2020 E-Congress; June 3-6, 2020. Abstract OP0018.