OP0030 TAPERING DMARDS IN THE TREACH TRIAL - FLARE RATES, SUSTAINED REMISSION AND RADIOLOGICAL PROGRESSION

Objectives Objective of this study was to investigate whether the initial treatment strategy that included triple DMARD therapy or methotrexate monotherapy differed at 24 months in the tREACH trial in their: (i) DAS, HAQ and X-ray progression (ii) Prevalence of flares (iii) Prevalence of attaining DAS 44 (iv) Prevalence of drug free remission at 24 months of follow-up Methods Data were used from patients with recent-onset arthritis participating in a single-blinded clinical trial (treatment in the Rotterdam Early Arthritis CoHort (tREACH)) [1,2] in which induction therapy strategies were compared: (A) combination therapy (methotrexate (MTX) + sulfasalazine + hydroxychloroquine) with glucocorticoid (GCs) bridging or (B) MTX with bridging GCs. Disease activity scores (original DAS) were assessed every 3 months. Functional ability was assessed using the Health assessment questionnaire (HAQ). Actual medication use was obtained from medical charts and from patient diaries. DMARDs (synthetic (s) and/or biologic (b)) were tapered stepwise by protocol if DAS was Results 281 rheumatoid arthritis patients (68% female; mean DAS 3.4, median HAQ 1.00) were initially randomized. After two years the difference in HAQ between group A and B was significantly different, irrespective of the DAS. Radiographic progression was minimal and similar for both groups, irrespective of tapering. Data on DMARD use at 2 years were available from 248 patients (88%). Over time 139 of 281 (49%) patients (group A: 93 (51%), group B: 46 (47%)) attained DAS Conclusions Half of patients in the tREACH trial was able to taper down medication after reaching sustained remission between 6 and 24 months of follow-up. Drug free remission was achieved by 11% of patients. Prevalence, time of initiation, radiographic progression and success of tapering were not different among the initial treatment groups. HAQ scores were significantly higher in the MTX monotherapy group compared to the triple DMARD therapy group. References Claessen et al. BMC Musculoskelet Disord 2009;10:71. De Jong et al. Ann Rheum Dis. 2013 Jan;72(1):72-8. Disclosure of Interest None declared