OP0036 Fewer Patients on Biologicals and Better Functional Ability Two Years after Induction Therapy with Combination DMARD Therapy versus Methotrexate Monotherapy
Authors: M. Kuijper, A. Weel, P. de Jong, A. Gerards, J. van Zeben, I. Tchetverikov, P. de Sonnaville, M. van Krugten, B. Grillet, M. Hazes, J. Luime
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Fewer patients on biologicals and better functional ability two years after induction therapy with combination DMARD therapy versus methotrexate monotherapy <h3>Objectives</h3> To assess differences in frequency of biological therapy use in early RA patients two years after starting induction therapy according to three different treatment regimens <h3>Methods</h3> Data were used from patients with recent-onset arthritis participating in a single-blinded clinical trial (Treatment in the Rotterdam Early Arthritis CoHort (tREACH)) [1,2] in which three induction therapy strategies were compared: (A) combination therapy (methotrexate (MTX) + sulfasalazine + hydroxychloroquine) with glucocorticoids (GCs) intramuscularly; (B) combination therapy with an oral GC tapering scheme and (C) MTX with oral GCs similar to B. Disease activity scores (original DAS) were assessed every 3 months. Functional ability was assessed using the Health assessment questionnaire (HAQ). Actual medication use was obtained from medical charts and from patient diaries. Data were analysed using simple descriptive statistical techniques. <h3>Results</h3> 281 patients (91 men, 190 women; mean baseline DAS 3.4, median baseline HAQ 0.75) were initially randomized. Data on medication use at 2 years were available from 166 patients (59%). Mean DAS was 1.72 (95%CI 1.59-1.86) at 24 months with similar results for the initial treatment groups A-C. DAS remission (DAS&lt;1.6) was achieved by 50% of patients. Median HAQ (min-max) was 0.38 (0-2) for all patients but varied in the treatment groups: A. 0.13 (0-1.6), B. 0.44 (0-2) and C. 0.63 (0-2). HAQ was significantly higher in group C versus A (p=0.042), while no significant difference was observed for group A versus B (p=0.39). Conventional DMARDs <i>only</i> were used in 58% of patients (A. 60%, B. 75% and C. 43%). Biological DMARDs <i>only</i> were used in 5% of patients (A. 8%, B. 2% and C 7.%). Thirteen percent of patients did not use any DMARD at all (A. 14%, B. 9% and C. 16%). Patients in group C used biological DMARDs more often compared to B (p=0.004), but no statistical difference was observed between groups A and B (p=0.241). <h3>Conclusions</h3> We observed lower use of biological therapy and better functional ability in induction triple therapy compared to induction monotherapy MTX with GC bridging at 2 years of follow-up in the treat-to-target tREACH study. No differences were found for disease activity scores. <h3>References</h3> Claessen et al. Use of risk stratification to target therapies in patients with recent onset arthritis; design of a prospective randomized multicenter controlled trial. BMC Musculoskelet Disord 2009;10:71. De Jong et al. Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann Rheum Dis. 2013 Jan;72(1):72-8. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.5357