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

M. M.A. Verhoeven*, P. M.J. Welsing, J. W.J. Bijlsma, J. M. van Laar, F. P.J.G. Lafeber, J. Tekstra, J. W.G. Jacobs

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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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.

Original languageEnglish
Article number24
JournalCurrent Rheumatology Reports
Volume21
Issue number6
DOIs
Publication statusPublished - 23 Apr 2019

Keywords

  • bDMARDs
  • csDMARDs
  • Early rheumatoid arthritis
  • GCs
  • Induction therapy
  • Standard care

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