Early intervention may reduce onset of RA
MADRID — Early therapeutic intervention for patients with pre-rheumatoid arthritis may significantly reduce the odds for full onset of the disease, according to findings from a meta-analysis presented at the Annual European Congress of Rheumatology.
Bruno Fautrel, MD, PhD, of the Departments of Epidemiology, Rheumatology and Clinical Immunology at Pierre and Marie Curie University in Paris, and colleagues aimed to assess the efficacy of early intervention in rheumatoid arthritis (RA). “Twenty years ago, we used to pre-treat patients,” he said.
The objective was to assess the efficacy of steroids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biological DMARDs in preventing RA appearance and structural damage in patients with undifferentiated or very early RA. Primary outcome measures included RA occurrence at 52 weeks and beyond and the absence of radiographic progression at week 52, according to Fautrel. The final analysis included 1,156 patients from nine randomized controlled trials, after an analysis of 595 data sets.
“We performed a classical systematic review,” he said, noting investigators reviewed PubMed, Embase and Cochrane databases in addition to reviewing meeting presentations through September 2016. “We hoped for a better understanding of the mechanism of disease, to identify it in the early stages.”
Eight of the studies pertained to undifferentiated RA and one study pertained to very early RA. Data for RA occurrence at 52 weeks were available in eight studies. Treatment methods included 80 mg to 120 mg methylprednisolone, methotrexate, tumor necrosis factor inhibitors, abatacept or rituximab. Results indicated early therapeutic intervention yielded a pooled reduction in the incidence of RA (odds ratio [OR] = 0.72).
“All treatments were approximately the same,” Fautrel said.
A similar outcome was reported for the absence of radiographic progression for all treatment methods or placebo (pooled OR = 1.36).
“There was no significant different for absence of radiographic progression,” Fautrel said.
Patients experienced symptoms for a mean duration of 16.2 ± 12.6 weeks.
“This meta-analysis demonstrates that early therapeutic intervention significantly reduces the risk of RA onset in pre-RA patients,” Fautrel said. — by Rob Volansky
Hugues B, et al. Abstract #OP0011. Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.
Disclosure: The researchers report no relevant financial disclosures.