No Difference in Intensive vs Routine Treatment in DMARD-Free Remission in RA

physician examining hand of patient
physician examining hand of patient
In The Netherlands, researchers found data that revealed no long-term benefits of an intensive disease activity score steered treatment regimen vs routine care to achieve disease-modifying antirheumatic drug-free sustained remission in patients with rheumatoid arthritis.

The use of intensive treatment did not show an increase in disease-modifying antirheumatic drug (DMARD)-free maintained remission in patients with rheumatoid arthritis (RA), according to results from a study published in Arthritis Research & Therapy.

Researchers conducted a prospective, population-based cohort study of 279 patients with RA who were followed for a median duration of 7.8 years. Among those included, 155 participants had a disease activity score less than 1.6 with a treatment goal of DMARD-free remission and 124 participants were treated with routine care and had a disease activity score of less than 2.4. Initial therapy consisted of methotrexate plus high-dose (60 mg per day) prednisone, with the potential to start biologic therapy after 4 months. The proportion of DMARD-free maintained remission and DMARD-free remission were compared between the groups.

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After analysis, the researchers found no significant association between DMARD-free remission and remission with intensive treatment (29% vs 35%; corrected hazard ratio, 1.4; 95% CI, 0.9-2.2). In addition, they reported that in patients with anti-citrullinated protein antibodies (ACPA)-positive RA, intensive treatment led to increased DMARD-free remission (25% vs 6%; corrected hazard ratio, 4.9; 95% CI, 1.4-17).

One key limitation of the study was the difference in baseline characteristics of study participants.

“Intensive treatment did not result in more DMARD-free sustained remission, compared to routine up-to-date care,” the researchers wrote.

“The data showed a tendency towards an effect of intensive treatment in ACPA-positive RA; this needs further investigation,” they concluded.


Burgers LE, van der Pol JA, Huizinga TWJ, Allaart CF, van der Helm-van Mil AHM. Does treatment strategy influence the ability to achieve and sustain DMARD-free remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care. Arthritis Res Ther. 2019;21(1):115.