Abstract
The objective of this study is to characterize stability and clinical features of patients with rheumatoid arthritis (RA) in sustained remission. Combination therapy with methotrexate and tumor necrosis factor inhibitors (TNFi) has increased remission rates in RA but optimal regimens to maintain remission are unknown. We describe Study of Etanercept And Methotrexate in Combination or as Monotherapy in Subjects with Rheumatoid Arthritis (SEAM-RA) and data from a run-in period of longitudinal observation. Patients in Simplified Disease Activity Index (SDAI) remission (score ≤ 3.3) receiving etanercept and methotrexate were screened and had to maintain remission over 3 run-in visits/24 weeks before randomization to combination therapy or withdrawal of etanercept or methotrexate. Baseline characteristics were examined for predictive factors for maintaining remission. As of November 2016, 141 patients have enrolled; of these, 64 have been randomized, 34 were ineligible after run-in, and 43 are in run-in period; 70% have completed run-in. Enrolled and randomized patients, respectively, had mean (standard deviation [SD]) disease duration 11.0 (8.6) and 12.6 (9.7) years; mean (SD) duration of etanercept use 4.2 (3.8) and 4.9 (4.2) years; mean (SD) methotrexate dose 15.9 (4.8) and 15.5 (4.9) mg/week; and mean (SD) SDAI scores 1.5 (0.9) and 1.4 (0.8). At enrollment, 73% and 63% were in Boolean remission based on 28 joints and 66/68 joints, respectively. No enrollment characteristic predicted successful completion of run-in. Two-thirds of patients considered to be in remission at enrollment sustained remission through 24 weeks. Baseline characteristics of enrolled patients and those who completed run-in were comparable.
Highlights
The American College of Rheumatology (ACR) [1] and the European League Against Rheumatism (EULAR) [2] both recommend low disease activity (LDA) or remission as the Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.University of Leeds, Chapel Allerton Hospital, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK goal of treatment for patients with rheumatoid arthritis (RA)
ACR and EULAR define remission based on Simplified Disease Activity Index (SDAI) score ≤ 3.3 or Boolean remission [3]
The benefits of maintaining good disease control have been amply demonstrated, and there is evidence that remission may lead to better outcomes compared to LDA [5,6,7,8]
Summary
ACR and EULAR define remission based on Simplified Disease Activity Index (SDAI) score ≤ 3.3 or Boolean remission (tender joint count [TJC] ≤ 1, swollen joint count [SJC] ≤ 1, C-reactive protein [CRP] ≤ 1 mg/dL, and patient global assessment [PGA] ≤ 1 on a 0–10 scale) [3]. The introduction of biologic therapies, including tumor necrosis factor inhibitor (TNFi) medications, for the treatment of moderate to severe RA has made remission more achievable than was previously seen with conventional synthetic disease-modifying
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
