Can remission be increased in patients with rheumatoid arthritis by using more biologics and less corticosteroids under real-life conditions?

This study evaluated the 7-year follow-up remission rate and maintenance in patients with rheumatoid arthritis (RA) under real-life conditions and identified factors related to long-term remission. The authors concluded that at 7 years nearly twice as many patients were in remission than at 1 year of follow-up and those patients had mainly received co-prescription with disease-modifying anti-rheumatic drugs (DMARDs).

RA is a long-term inflammatory disease that causes swollen joints, pain, stiffness, and disabilities. Remission is an important goal in RA treatment. Patients in remission experience an absence or reduction in signs or symptoms of the disease. As a result, their ability to perform functions is enhanced, better productivity is achieved, economic burdens are reduced and their overall quality of life is improved.

Newer therapies like conventional synthetic DMARDs (csDMARDs) and biological DMARDs (bDMARDs) have made remission an achievable treatment target. However, evidence suggests that under real-life conditions the remission level may be lower than expected. Since RA remission varies from patient to patient, prognostic factors may be important in estimating the extent to which remission occurs or is maintained and needs to be investigated.

This study analyzed the records of 310 patients with RA after 1 year of follow-up and 215 patients with RA after 7 years of follow-up under real-life conditions. RA treatments included csDMARDs only, bDMARDs only, corticosteroids, combined treatment with csDMARDs and bDMARDs (co-prescription), or no DMARDs. Disease activity was determined using 28 joints (DAS28). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood markers that evaluated inflammatory response.

At 7 years, 57.7% of patients were in remission compared to 33% of patients at 1 year of follow-up. 48.6% of patients that were not in remission at 1 year obtained remission at 7 years of follow-up.

Patients that received co-prescription with csDMARDs and bDMARDs achieved remission more frequently. Patients in remission at 1 year had a greater chance of maintaining remission until 7 years, with 76% of patients in long-term sustained remission. 

Patients who were not in remission after 7 years were more often given corticosteroids and in higher doses. 

The factors that predicted maintenance of remission after 7 years were a low initial activity of RA, use of csDMARDs and of bDMARDs. 

The study showed that patients with RA achieved DAS28 remission with fewer corticosteroids and more biologics during a 7-year follow-up.

The study used the DAS28 score to measure disease activity which can sometimes lead to overestimation. A large number of patients were unable to complete the 7-year follow-up.