Achievement of Remission in Two Early Rheumatoid Arthritis Cohorts Implementing Different Treat-to-Target Strategies

Abstract

Objective: The objective of this study was to compare achievement of remission in 2 early rheumatoid arthritis (RA) treat-to-target (TTT) cohorts, a tight control cohort with a target of stringent remission in a randomized controlled trial and an observational cohort targeting a looser definition of remission in clinical practice. Methods: We analyzed data from the Aiming for Remission in Rheumatoid Arthritis: a randomised trial examining the benefit of ultrasound in a Clinical Tight Control regimen (ARCTIC) trial and the Norwegian Very Early Arthritis Clinic (NOR-VEAC) observational study. Both were Norwegian multicenter studies that included disease-modifying antirheumatic drug (DMARD)–naive RA patients and implemented TTT. The target in the ARCTIC trial was remission defined as a Disease Activity Score (DAS) of <1.6 plus 0 swollen joints on a 44-joint count, while the target in the NOR-VEAC study was the less stringent remission target of a DAS28 of <2.6. We assessed achievement of the study-specific targets and compared the odds of achieving the American College of Rheumatology(ACR)/European League Against Rheumatism (EULAR) Boolean remission during 2 years of follow-up. Results: We included 189 patients from the ARCTIC trial and 330 patients from the NOR-VEAC study. The study-specific target had been achieved in more than half of the patients in each cohort at 6 months, increasing to >60% at 12 and 24 months. The odds of achieving ACR/EULAR Boolean remission during follow-up were higher in the ARCTIC trial than in the NOR-VEAC study, with significant differences at 3 months (odds ratio 1.73 [95% confidence interval 1.03–2.89]), 12 months (odds ratio 1.97 [95% confidence interval 1.21–3.20]), and 24 months (odds ratio 1.82 [95% confidence interval 1.05–3.16]). Conclusion: A majority of patients in both cohorts reached the study-specific treatment targets. More patients in the ARCTIC trial than in the NOR-VEAC study achieved ACR/EULAR Boolean remission during follow-up, suggesting that targeting a more stringent definition of remission provides further potential for favorable outcomes of a TTT strategy.