Tight control in the treatment of rheumatoid arthritis: efficacy and feasibility

• Published in: Annals of the rheumatic diseases Vol. 66; no. suppl 3; pp. iii56 - iii60
• Main Authors: Bakker, M F, Jacobs, J W G, Verstappen, S M M, Bijlsma, J W J
• Format: Journal Article Conference Proceeding
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.11.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Cameras; Diseases of the osteoarticular system; Drug Therapy, Combination; Humans; Inflammatory joint diseases; Medical sciences; Methotrexate - therapeutic use; Patients; Randomized Controlled Trials as Topic; Remission (Medicine); Remission Induction - methods; Research Design; Rheumatism; Rheumatoid arthritis; Supplement; Treatment Outcome; Human; Immunopathology; Chronic; Treatment; Computer simulation; Rheumatoid arthritis; Diseases of the osteoarticular system; Autoimmune disease; Clinical trial; Inflammatory joint disease; Feasibility
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2007.078360

Objective:To evaluate the available evidence on the efficacy and feasibility of the new concept of tight control in randomised trials in patients with rheumatoid arthritis (RA). Tight control is a treatment strategy tailored to the individual patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time.Methods:The literature database PubMed was searched and yielded four trials: the FIN-RACo trial, the TICORA study, the BeSt study and the CAMERA study.Results:Tight control resulted in greater improvement and a higher percentage of patients meeting the preset aim of low disease activity or remission when compared to the control intervention. In the FIN-RACo trial, aimed at DAS28<2.6, 51% of patients in the tight control group achieved remission versus 16% in the contrast group (p<0.001). In the TICORA study, 65% of patients in the tight control group versus 16% of the contrast group achieved remission, based on DAS<1.6 (p<0.0001). In the CAMERA study, 50% of patients in the tight control group using a computer decision model achieved remission, versus 37% in the contrast group (p = 0.029). The BeSt study consisted of only tight control groups aimed at a DAS<1.6; remission was achieved in 38–46% of patients. This is higher than the range of remission in earlier trials of 13–36%.Conclusion:Tight control aiming for low disease activity or even better still, remission, seems a promising option in treating patients with RA in clinical trials and probably also in daily practice.