Early treatment of rheumatoid arthritis (RA) using disease-modifying antirheumatic drugs (DMARDs) can lead to long-term remission of the disease, according to a Dutch study of newly diagnosed RA patients who followed a pharmaceutical protocol called treat-to-target that specifically aims at inducing remission. The study was published recently online in Arthritis Care & Research.

Previous studies have shown that early, intensive intervention can help RA patients achieve remission, and reduce joint damage and disability. Treat-to-target (T2T) is a medical strategy that sets remission – or at the very least, low disease activity – as a goal; specific drugs and doses are stepped up systematically if remission is not reached within certain time periods. 

Earlier findings of this Dutch study – called the DREAM trial – showed that remission can be achieved using the T2T strategy among patients with early RA (with symptom duration of one year or less) in the everyday world of daily clinical practice. But could the remission be sustained over the long-term?

A total of 342 patients from the DREAM trial had three-year follow up data for this phase of the analysis. Among them, nearly 62 percent were in remission at the three-year mark. Remission was defined as having a DAS28 score of less than 2.6. DAS28 measures disease activity in 28 key joints and certain blood markers.

Sustained DAS28 remission – defined as a DAS28 of less than 2.6 for six months or more – was achieved by more than 70 percent of patients at least once during the three years, with nearly 75 percent of those patients achieving a sustained remission for greater than a year. At the end of the three-year period, about 43 percent of the study subjects were in a period of sustained remission. The protocol called for a gradual decrease in medication for those experiencing sustained remission – and eventual discontinuation of drug therapy. At the three-year mark, a quarter of the subjects in the remission group were taking no medications.  

“Our study showed that T2T results in low disease activity and high [sustained] remission rates, improved physical function, better health-related quality of life and limited radiographic damage, which sustain over three years,” says lead study author Marloes Vermeer, PhD candidate, a researcher at the Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.