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. 2023 Aug;10(4):875-886.
doi: 10.1007/s40744-023-00551-3. Epub 2023 May 14.

Should We Use bDMARDs as an Induction Therapy in Early and Severe Rheumatoid Arthritis? Results at 5 years from the ERA UCLouvain Brussels Cohort

Emilie Sapart  1 , Tatiana Sokolova  1 , Stéphanie de Montjoye  1 , Stéphanie Dierckx  2 , Adrien Nzeusseu  1 , Aleksandra Avramovska  1 , Laurent Meric de Bellefon  1 , Patrick Durez  3
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Should We Use bDMARDs as an Induction Therapy in Early and Severe Rheumatoid Arthritis? Results at 5 years from the ERA UCLouvain Brussels Cohort

Emilie Sapart et al. Rheumatol Ther. 2023 Aug.

Abstract

Introduction: This study sought to analyze the benefit of an early induction therapy with a biological disease-modifying anti-rheumatic drugs (bDMARD) during the first year of treatment with a 5-year follow-up in early rheumatoid arthritis (ERA).

Methods: We included ERA patients from the UCLouvain Brussels cohort who met the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 classification criteria and were naïve to DMARDs. ERA patients were divided into two groups according to whether they received an induction bDMARD therapy or a standard therapy with methotrexate (MTX). Clinical response after the induction treatment at 6 and 12 months followed by a MTX maintenance therapy at 36 and 60 months was evaluated.

Results: Data from 470 ERA patients were collected, 189 received a bDMARD and 281 initiated MTX alone. In the bDMARD group, disease activity and HAQ were higher at baseline. A total of 391 patients were followed up to 5 years. We then divided each group into two subgroups according to the last treatment they received at 5 years: bDMARD > MTX (n = 95), bDMARD > bDMARD (n = 59); MTX > MTX (n = 134), MTX > bDMARD (n = 103). During the induction, we observed a clinical response with a large number of patients achieving DAS28-CRP remission. According to a treat-to-target (T2T) approach, remission rate was stable on MTX monotherapy or rescued by the addition or prolongation of a bDMARD. Interestingly, bDMARD followed by a MTX maintenance therapy experienced a stable and sustained DAS28-CRP remission rate in 53% of the ERA patients at year 5.

Conclusions: Long-term remission is an achievable goal in ERA. Our results suggest that a bDMARD induction therapy followed by MTX maintenance therapy could be an interesting option.

Keywords: Biological versus conventional synthetic DMARDs; Early arthritis; Rheumatoid arthritis.

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Conflict of interest statement

Emilie Sapart, Tatiana Sokolova, Stéphanie de Montjoye, Stéphanie Dierckx, Adrien Nzeusseu, Aleksandra Avramovska, Laurent Meric de Bellefon and Patrick Durez have nothing to disclose.

Figures

Fig. 1
Fig. 1
Comparison of DAS28-CRP, CDAI, and SDAI remission scores evolution in the four groups
See this image and copyright information in PMC

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