Remission in rheumatoid arthritis: missing objectives by using inadequate DAS28 targets

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For too long, the definition of ‘remission’ in rheumatoid arthritis has been distorted by the widespread use of an inadequate tool, with consequences for clinical care and for making sense of clinical trial data. Has the time come to move away from DAS28-defined remission?

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Fig. 1: Distinct effects of different therapies on DAS28-defined remission.

References

  1. 1.

    Felson, D. T. et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann. Rheum. Dis. 70, 404–413 (2011).

  2. 2.

    Aletaha, D. & Smolen, J. S. Joint damage in rheumatoid arthritis progresses in remission according to the Disease Activity Score in 28 joints and is driven by residual swollen joints. Arthritis Rheum. 63, 3702–3711 (2011).

  3. 3.

    Schoels, M. et al. Evaluation of newly proposed remission cut-points for disease activity score in 28 joints (DAS28) in rheumatoid arthritis patients upon IL-6 pathway inhibition. Arthritis Res. Ther. 19, 155 (2017).

  4. 4.

    Linde, L. et al. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important? 37, 285–290 (2010).

  5. 5.

    Thiele, K. et al. Performance of the 2011 ACR/EULAR preliminary remission criteria compared with DAS28 remission in unselected patients with rheumatoid arthritis. Ann. Rheum. Dis. 72, 1194–1199 (2013).

  6. 6.

    Smolen, J. S. et al. Brief Report: Remission rates with tofacitinib treatment in rheumatoid arthritis: a comparison of various remission criteria. Arthritis Rheumatol. 69, 728–734 (2017).

  7. 7.

    Orange, D. E. et al. Histologic and transcriptional evidence of subclinical synovial inflammation in rheumatoid arthritis patients in clinical remission. Arthritis Rheumatol. 71, 1034–1041 (2019).

  8. 8.

    Tanaka, Y. et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. 74, 389–395 (2015).

  9. 9.

    Smolen, J. S. et al. Impact of flare on radiographic progression after etanercept continuation, tapering or withdrawal in patients with rheumatoid arthritis. https://doi.org/10.1093/rheumatology/kez224 (2019).

  10. 10.

    Food and Drug Administration. Rheumatoid arthritis: Developing drug products for treatment [draft guidance document]. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/rheumatoid-arthritis-developing-drug-products-treatment (2013).

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Correspondence to Daniel Aletaha or Josef S. Smolen.

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Competing interests

D. Aletaha declares that he has received personal fees from AbbVie, Eli Lilly, Janssen, Medac, Merck Sharp & Dohme, Pfizer, Roche, Sanofi/Genzyme and UCB, and grants from AbbVie, Bristol-Myers Squibb, and Merck Sharp & Dohme. J.S. Smolen declares that he has received grants for his institution from AbbVie, AstraZeneca, Janssen, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer and Roche, and that he has provided expert advice or had symposia speaking engagements for AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Eli Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi and UCB.

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