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

Abstract

Objective To compare achievement of remission in two early rheumatoid arthritis (RA) treat‐to‐target (TTT) cohorts, one tight control cohort targeting stringent remission in a randomized controlled strategy trial and one observational cohort targeting a looser definition of remission in clinical practice. Methods We analyzed data from the ARCTIC trial and the NOR‐VEAC observational study. Both were Norwegian multicenter studies including disease modifying anti‐rheumatic drug (DMARD)‐naïve RA‐patients and implementing TTT. The target in ARCTIC was remission defined as a Disease Activity Score (DAS44) <1.6 plus 0 of 44 swollen joint count, while the target in NOR‐VEAC was the less stringent remission of DAS28<2.6. We assessed achievement of the study‐specific targets and compared achievement of the ACR/ EULAR Boolean remission during two years of follow‐up. Results We included 189 patients from ARCTIC and 330 patients from NOR‐VEAC. More than half in each cohort had reached the study‐specific target at 6 months, increasing to more than 60% at 12 and 24 months. The odds of reaching ACR/EULAR Boolean remission during follow‐up were higher in ARCTIC than in NOR‐VEAC, with statistically significant differences at 3 months (OR 1.73; 95% CI 1.03‐2.89), 12 months (OR 1.97; 95% CI 1.21‐3.20) and 24 months (OR 1.82; 95% CI 1.05 – 3.16). Conclusion A majority of patients in both cohorts reached the study‐specific treatment targets. More patients in ARCTIC than in NOR‐VEAC achieved ACR/EULAR Boolean remission during follow‐up, suggesting that targeting a more stringent definition of remission provide further potential for favorable outcomes of a TTT strategy.