In patients with both early and established rheumatoid arthritis (RA), intensive treatment with combination disease-modifying antirheumatic drugs (DMARDs), biologics, or Janus kinase (JAK) inhibitors increases the likelihood of achieving remission, according to results published in BMC Musculoskeletal Disorders.

The researchers performed a systematic literature review and meta-analysis of trials and comparative studies that reported remission in patients with RA who were treated intensively with DMARDs, biologics, and JAK inhibitors. They used RevMan 5.3 to report relative risks (RR) in random effects models.

The researchers identified 928 publications and included 53 studies. These studies included 48 superiority studies and 6 head-to-head trials. In the superiority studies, 3013 of 11,259 participants achieved remission with intensive treatment compared with 1211 of 8493 controls.


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After analyzing the 53 studies, the researchers found a significant benefit for intensive treatment (RR, 2.23; 95% CI, 1.90-2.61). They found that intensive treatment increased the number of remissions in both participants with early RA (23 comparisons; RR, 1.56; 95% CI, 1.38-1.76) and established RA (29 comparisons; RR, 4.21; 95% CI, 2.92-6.07).

In the 6 head-to-head trials, the results indicated that 316 of 787 participants achieved remission with biologics compared with 229 of 671 of participants receiving combination DMARD therapies. There was no difference between treatment strategies (RR, 1.06; 95% CI, 0.93-1.21).

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However, the researchers did find differences in the frequency of remissions between early and established RA. Among participants with early RA, the frequency of remission with active treatment was 49% compared with 34% in controls. Among participants with established RA, the frequency of remission with active treatment was 19% compared with 6% in controls.

“The relative merits of different remission criteria in trials is a complex question but changing criteria has the disadvantage of making it difficult to compare trials with newer criteria and those using more historic methods,” the researchers wrote.

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Reference

Hughes CD, Scott DL, Ibrahim F; on behalf of TITRATE Programme Investigators. Intensive therapy and remissions in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord. 2018;19:389.