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| |  Early Response to Anti-TNF Treatment Predicts Better Long-Term Outcomes: Presented at EULAR By Rhonda Siddall ROME -- June 23, 2010 -- During the closing statements here at the 2010 Annual Meeting of the European League Against Rheumatism (EULAR), president Paul Emery, MD, University of Leeds, Leeds, United Kingdom, urged rheumatologists to heed the new recommendations from EULAR on the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs. New guidelines issued by EULAR during the meeting recommend a more intensive, targeted approach to the management of RA. An expert committee produced 15 recommendations for the treatment of RA. Principal amongst these are recommendations to aim for patients to achieve a state of low disease activity or remission by adjusting treatment every 1 to 3 months. "The treatment target should be reached, or almost reached, within 3 months and definitely attained by a maximum of 6 months as we know that such an approach is associated with a better clinical, radiographic, and functional outcome," said Dr. Emery on June 19. The recommendations were based on systematic literature reviews. New data presented during the conference provides further confirmatory evidence that an early response to treatment is paramount in terms of maximising long-term outcomes, Dr. Emery told Doctor's Guide. Responding early to anti-tumour necrosis factor (TNF) treatment is important in estimating the long-term effectiveness of therapy and could be used to optimise treatment strategies, he added. A new follow-up of patients from the Rheumatoid Arthritis Prevention of Structural Damage (RAPID 1) study of certolizumab pegol showed that patients treated with certolizumab pegol and methotrexate who achieved a rapid and greater response to treatment by week 12 were more likely to have low disease activity 2 years later than patients who achieved a slower or lower response to treatment. Lead investigator from the RAPID 1 study Edward Keystone, MD, University of Toronto, Toronto, Ontario, said, "We are seeing a new concept emerging from these data that even in established disease you get early and late responders and this makes a difference to long-term outcomes. Lack of sustained long-term achievement of LDA [low disease activity] with certolizumab pegol can be predicted early in the course of treatment." Further new data from the 2-year Combination of Methotrexate and Etanercept in Active Early Rheumatoid Arthritis (COMET) trial presented at EULAR showed that a greater proportion of patients treated with etanercept plus methotrexate versus methotrexate alone within 4 months of diagnosis achieved clinical remission compared with patients treated after at least 4 months following diagnosis. "These data provide further evidence of the importance of intervening early in RA," said Dr. Emery. "Furthermore, evidence of the importance of TNF in the pathogenesis in the early phase of disease and the qualitative better outcomes that occurs with combination therapy which is not seen with methotrexate alone suggesting optimal time for TNF blockade to be used. Early intervention, frequent monitoring of treatment response and management aimed at treating RA to a target of remission or low disease activity should be the guiding principles of RA management." COMET data showed that nearly 70% of the 63 patients with RA who were treated very early (within 4 months of diagnosis) with etanercept and methotrexate achieved remission compared with 48% of those treated early (at least 4 months after diagnosis) with the combination regimen. Only 35% of the patients treated very early with methotrexate alone achieved remission, and only 32% of the patients treated early with methotrexate alone achieved remission. [Presentation title: Very Early (<4 MONTHS) Treatment With Combination Etanercept (ETN) and Methotrexate (MTX) Produces Significantly Better Remission Rates: Results From the Comet Study. Abstract LB0001]
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