The newly published 5-year outcomes of the IMPROVED trial demonstrate the feasibility of achieving long-term drug-free remission in early rheumatoid arthritis (RA). These findings raise the bar and support the use of a remission induction and maintenance approach, particularly in patients presenting with early joint inflammation consistent with early RA.
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References
Kuijper, T. M., Lamers-Karnebeek, F. B., Jacobs, J. W., Hazes, J. M. & Luime, J. J. Flare rate in patients with rheumatoid arthritis in low disease activity or remission when tapering or stopping synthetic or biologic DMARD: a systematic review. J. Rheumatol. 42, 2012–2022 (2015).
Akdemir, G. et al. Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study. Ann. Rheum. Dis. 77, 111–118 (2017).
Heimans, L. et al. A two-step treatment strategy trial in patients with early arthritis aimed at achieving remission: the IMPROVED study. Ann. Rheum. Dis. 73, 1356–1361 (2014).
Heimans, L. et al. Two-year results of disease activity score (DAS)-remission-steered treatment strategies aiming at drug-free remission in early arthritis patients (the IMPROVED-study). Arthritis Res. Ther. 18, 23 (2016).
Akdemir, G. et al. Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study. RMD Open 2, e000172 (2016).
Emery, P. et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active-controlled AVERT study of 24 months, with a 12-month, double-blind treatment period. Ann. Rheum. Dis. 74, 19–26 (2015).
Emery, P. et al. Sustained remission with etanercept tapering in early rheumatoid arthritis. N. Engl. J. Med. 371, 1781–1792 (2014).
Acknowledgements
V.P.B. has received grants from the National Institutes of Health, Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research.
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V.P.B. declares she has acted as an adviser for Amgen, BMS, Pfizer, Sanofi-Genzyme and UCB, and that her institute has received research funding from Amgen, BMS and UCB.
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The IMPROVED trial 1 year and 2 year outcomes (PDF 86 kb)
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Bykerk, V. Moving towards IMPROVED drug-free remission. Nat Rev Rheumatol 14, 191–192 (2018). https://doi.org/10.1038/nrrheum.2018.49
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DOI: https://doi.org/10.1038/nrrheum.2018.49