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. 2019 Apr 23;21(6):24.
doi: 10.1007/s11926-019-0821-1.

Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

M M A Verhoeven  1 , P M J Welsing  2 , J W J Bijlsma  2 , J M van Laar  2 , F P J G Lafeber  2 , J Tekstra  2 , J W G Jacobs  2
Affiliations

Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

M M A Verhoeven et al. Curr Rheumatol Rep. .

Abstract

Purpose of review: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA.

Recent findings: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.

Keywords: Early rheumatoid arthritis; GCs; Induction therapy; Standard care; bDMARDs; csDMARDs.

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Conflict of interest statement

Dr. Lafeber reports grants from Roche, outside the submitted work.

Dr. Bijlsma reports grants from Pfizer, grants from Merck Sharp & Dohme, grants from Bristol-Myers Squibb, grants from AbbVie, grants from Roche, outside the submitted work.

Dr. van Laar reports grants from Arthrogen, grants from MSD, personal fees from Pfizer, personal fees from Eli Lilly, personal fees from BMS, grants from Astra Zeneca, grants from Roche-Genentech, outside the submitted work.

M.M.A. Verhoeven, P.M.J. Welsing, J. Tekstra and J.W.G. Jacobs declare they have no conflicts to disclose.

Figures

Fig. 1
Fig. 1
Forest plot of DAS28 remission outcome in individual studies comparing remission induction strategies with single csDMARD-initiating strategies. DAS28 remission, DAS28 < 2.6; induction, remission induction strategy arm; csDMARD, single csDMARD-initiating strategy arm; M-H, Mantel-Haenszel; Random, random effect; *bDMARD-based remission induction strategy. 95% CI, 95% confidence interval
Fig. 2
Fig. 2
Forest plot of Boolean remission outcome in individual studies comparing remission induction strategies with single csDMARD-initiating strategies. Boolean remission—tender joint count ≤ 1, swollen joint count ≤ 1, CRP ≤ 1 mg/dL, patient global assessment ≤ 1 (on a 0–10 scale); induction, remission induction strategy arm; csDMARD, single csDMARD-initiating strategy arm; M-H, Mantel-Haenszel; random, random effect; *bDMARD-based remission induction strategy. 95% CI, 95% confidence interval
Fig. 3
Fig. 3
Forest plot of CDAI remission outcome in individual studies comparing remission induction strategies with single csDMARD-initiating strategies. CDAI remission, CDAI ≤ 2.8; induction, remission induction strategy arm; csDMARD, single csDMARD-initiating strategy arm; M-H, Mantel-Haenszel; random, random effect. 95% CI, 95% confidence interval
Fig. 4
Fig. 4
Forest plot of SDAI remission outcome in individual studies comparing remission induction strategies with single csDMARD-initiating strategies. SDAI remission, SDAI ≤ 3.3; induction, remission induction strategy arm; csDMARD, single csDMARD-initiating strategy arm; M-H, Mantel-Haenszel; random, random effect; *bDMARD-based remission induction strategy
See this image and copyright information in PMC

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