Strategies for optimal suppression of rheumatoid arthritis
Kooij, S.M. van der
Citation
Kooij, S. M. van der. (2009, January 22). Strategies for optimal suppression of rheumatoid arthritis. Retrieved from https://hdl.handle.net/1887/13425
Version: Corrected Publisher’s Version
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University of Leiden
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508 patients randomised
126 assigned to sequential monotherapy
(group 1)
6 withdrawals 9 excluded due to
>1 DAS missing
111 patients entered analysis
103 patients entered analysis
113 patients entered analysis
118 patients entered analysis 121 assigned to
step-up combination therapy
(group 2)
133 assigned to initial combination therapy incl. prednisone
(group 3)
128 assigned to initial combination therapy with MTX + infliximab
(group 4)
9 withdrawals 9 excluded due to
>1 DAS missing
4 withdrawals 6 excluded due to
>1 DAS missing 8 withdrawals
12 excluded due to
>1 DAS missing
Figure 1. Flowchart of the study.
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Table 1. Baseline demographic and disease characteristics.
Group 1 N=111
Group 2 N=103
Group 3 N=113
Group 4 N=118
P-value
DAS, mean (SD) 4.5 (0.9) 4.5 (0.8) 4.3 (0.9) 4.3 (0.8) 0.100 HAQ, mean (SD) 1.4 (0.7) 1.4 (0.6) 1.4 (0.7) 1.4 (0.7) 0.999
Women, no. (%) 77 (69) 76 (74) 72 (64) 77 (65) 0.387
IgM RF positive, no. (%) 77 (69) 65 (63) 73 (65) 74 (63) 0.712 Symptom duration,
median weeks (IQR)
23 (13-53) 26 (14-54) 23 (15-50) 23 (13-45) 0.819
Total SHS, median (IQR) 3.5 (2-9) 5.0 (2-8) 3.0 (2-8) 4.0 (1-8) 0.770
Age, mean (SD) years 54 (13) 54 (13) 55 (13) 54 (14) 0.965
DAS, disease activity score (44 joint count); HAQ, Health Assessment Questionnaire; IQR, interquartile range; RF, rheumatoid factor; SHS, Sharp-van der Heijde Score.
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Table 2. Duration and probability of maintaining low disease activity in early rheumatoid arthritis (RA) pa- tients treated according to different treatment strategies.
Overall Sequential mono (group 1)
Step-up combi (group 2)
Combi with prednisone (group 3)
Combi with infliximab (group 4)
P-value
DAS ≤2.4 at least once (%)
95 92 97 97 93 0.256
Time until DAS ≤2.4, median months (IQR)
6 (3-9) 9 (6-12) 9 (6-12) 3 (3-6) 3 (3-6) 0.001*
Duration first DAS ≤2.4, median months (IQR)
12 (3-21) 12 (6-21) 12 (3-21) 12 (3-24) 18 (6-24) 0.016†
Next DAS ≤2.4 after 1 DAS ≤2.4 (%)
74 77 69 71 79 0.288
Next DAS ≤2.4 after 2 DAS ≤2.4 (%)
85 89 85 75 90 0.013‡
DAS 1.6 at least once (%)
71 70 64 73 79 0.374
Time until DAS 1.6, median months (IQR)
9 (6-15) 12 (8-19) 12 (6-18) 6 (3-15) 6 (6-12) 0.001*
Duration first DAS 1.6, median months (IQR)
6 (3-12) 6 (3-15) 6 (3-9) 6 (3-10) 6 (3-15) 0.628
Next DAS ≤2.4 after 1 DAS 1.6 (%)
88 85 84 91 91 0.414
Next DAS ≤2.4 after 2 DAS 1.6 (%)
97 97 97 96 97 0.974
Flare (DAS 2.4) after 3 months (%)
26 23 31 29 21 0.288
Flare (DAS 2.4) after 6 months (%)
9 7 8 15 7 0.143
Flare (DAS 2.4) after 9 months (%)
6 7 6 4 6 0.765
Flare (DAS 2.4) after 12 months (%)
5 5 4 8 5 0.689
Flare (DAS 2.4) after 12 months (%)
6 6 3 8 6 0.581
No flare (DAS ≤2.4) (%) 48 52 47 37 56 0.038‡
* P 0.05, groups 1 and 2 vs groups 3 and 4; † P 0.05, group 4 vs groups 1, 2 and 3; ‡ P 0.05, group 3 vs groups 1 and 4. DAS, disease activity score (44 joint count); IQR, interquartile range.
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