Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)
Aim Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus p...
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| Veröffentlicht in: | Annals of the rheumatic diseases 2012-09, Vol.71 (9), p.1472-1477 |
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| creator | Wevers-de Boer, Kirsten Visser, Karen Heimans, Lotte Ronday, H Karel Molenaar, Esmeralda Groenendael, J Hans L M Peeters, André J Westedt, Marie-Louise Collée, Gerard de Sonnaville, Peter B J Grillet, Bernard A M Huizinga, Tom W J Allaart, Cornelia F |
| description | Aim Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA). Method 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified. Results With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p |
| doi_str_mv | 10.1136/annrheumdis-2011-200736 |
| format | Article |
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The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA). Method 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified. Results With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity. Conclusion Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2011-200736</identifier><identifier>PMID: 22402145</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><subject>Antirheumatic Agents - administration & dosage ; Antirheumatic Agents - therapeutic use ; Arthritis ; Arthritis - drug therapy ; Arthritis - pathology ; Biological and medical sciences ; Bones, joints and connective tissue. Antiinflammatory agents ; Classification ; Clinical trials ; Diseases of the osteoarticular system ; Drug Combinations ; Drug dosages ; Female ; HIV ; Human immunodeficiency virus ; Humans ; Inflammatory joint diseases ; Male ; Medical sciences ; Methotrexate - administration & dosage ; Methotrexate - therapeutic use ; Middle Aged ; Pharmacology. Drug treatments ; Prednisone - administration & dosage ; Prednisone - therapeutic use ; Remission Induction ; Rheumatology ; Substance abuse treatment ; Tuberculosis ; Variables</subject><ispartof>Annals of the rheumatic diseases, 2012-09, Vol.71 (9), p.1472-1477</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2012 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b382t-b5248eea0fbec5a172e1621466266112618ade000012a7f71812c62f287418353</citedby><cites>FETCH-LOGICAL-b382t-b5248eea0fbec5a172e1621466266112618ade000012a7f71812c62f287418353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/71/9/1472.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/71/9/1472.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26250277$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22402145$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wevers-de Boer, Kirsten</creatorcontrib><creatorcontrib>Visser, Karen</creatorcontrib><creatorcontrib>Heimans, Lotte</creatorcontrib><creatorcontrib>Ronday, H Karel</creatorcontrib><creatorcontrib>Molenaar, Esmeralda</creatorcontrib><creatorcontrib>Groenendael, J Hans L M</creatorcontrib><creatorcontrib>Peeters, André J</creatorcontrib><creatorcontrib>Westedt, Marie-Louise</creatorcontrib><creatorcontrib>Collée, Gerard</creatorcontrib><creatorcontrib>de Sonnaville, Peter B J</creatorcontrib><creatorcontrib>Grillet, Bernard A M</creatorcontrib><creatorcontrib>Huizinga, Tom W J</creatorcontrib><creatorcontrib>Allaart, Cornelia F</creatorcontrib><title>Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><description>Aim Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA). Method 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified. Results With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity. Conclusion Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.</description><subject>Antirheumatic Agents - administration & dosage</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis</subject><subject>Arthritis - drug therapy</subject><subject>Arthritis - pathology</subject><subject>Biological and medical sciences</subject><subject>Bones, joints and connective tissue. Antiinflammatory agents</subject><subject>Classification</subject><subject>Clinical trials</subject><subject>Diseases of the osteoarticular system</subject><subject>Drug Combinations</subject><subject>Drug dosages</subject><subject>Female</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Inflammatory joint diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methotrexate - administration & dosage</subject><subject>Methotrexate - therapeutic use</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisone - administration & dosage</subject><subject>Prednisone - therapeutic use</subject><subject>Remission Induction</subject><subject>Rheumatology</subject><subject>Substance abuse treatment</subject><subject>Tuberculosis</subject><subject>Variables</subject><issn>0003-4967</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkcFu1DAURSMEokPhF8ASQiqLgJ-T2J4lDC0UFYoKdDEby0leNB4SJ9iO2vkNvhinGUaIFRvbzz73-tk3SZ4BfQWQ8dfaWrfBsauNTxkFiAMVGb-XLCDnMlac3k8WlNIszZdcHCWPvN_GkkqQD5MjxnLKIC8Wya8r7Iz3prfE2HqswrQKG3R62JEbEzakw7Dpg8NbHZBoW5PBYW2N7y1GCRl0MGiDn2HUrt2Ru9Z06E19JxhtbZoGXcRMNImbLmycCcaTk3gVOf_05ery-vQd8WGsdy8fJw8a3Xp8sp-Pk-9np99WH9KLy_fnqzcXaZlJFtKyYLlE1LQpsSo0CIbA46M4Z5wDMA5S1zi9GZgWjQAJrOKsYVLkILMiO05OZt_B9T9H9EHFn6iwbbXFfvQKaJZBsaTFMqLP_0G3_ehs7E6BEEIKyfOJEjNVud57h40anOm020UrNcWm_opNTbGpObaofLr3H8sO64PuT04ReLEHtK902zhtq-hx4DgrKBMicunMGR_w9nCu3Q_FRSYK9fl6pT5-Xa5BrN-qdeTZzJfd9r-7_Q3LMMRh</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Wevers-de Boer, Kirsten</creator><creator>Visser, Karen</creator><creator>Heimans, Lotte</creator><creator>Ronday, H Karel</creator><creator>Molenaar, Esmeralda</creator><creator>Groenendael, J Hans L M</creator><creator>Peeters, André J</creator><creator>Westedt, Marie-Louise</creator><creator>Collée, Gerard</creator><creator>de Sonnaville, Peter B J</creator><creator>Grillet, Bernard A M</creator><creator>Huizinga, Tom W J</creator><creator>Allaart, Cornelia F</creator><general>BMJ Publishing Group Ltd and European League Against Rheumatism</general><general>BMJ Publishing Group</general><general>Elsevier Limited</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)</title><author>Wevers-de Boer, Kirsten ; Visser, Karen ; Heimans, Lotte ; Ronday, H Karel ; Molenaar, Esmeralda ; Groenendael, J Hans L M ; Peeters, André J ; Westedt, Marie-Louise ; Collée, Gerard ; de Sonnaville, Peter B J ; Grillet, Bernard A M ; Huizinga, Tom W J ; Allaart, Cornelia F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b382t-b5248eea0fbec5a172e1621466266112618ade000012a7f71812c62f287418353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Antirheumatic Agents - administration & dosage</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis</topic><topic>Arthritis - drug therapy</topic><topic>Arthritis - pathology</topic><topic>Biological and medical sciences</topic><topic>Bones, joints and connective tissue. Antiinflammatory agents</topic><topic>Classification</topic><topic>Clinical trials</topic><topic>Diseases of the osteoarticular system</topic><topic>Drug Combinations</topic><topic>Drug dosages</topic><topic>Female</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Inflammatory joint diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methotrexate - administration & dosage</topic><topic>Methotrexate - therapeutic use</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Prednisone - administration & dosage</topic><topic>Prednisone - therapeutic use</topic><topic>Remission Induction</topic><topic>Rheumatology</topic><topic>Substance abuse treatment</topic><topic>Tuberculosis</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wevers-de Boer, Kirsten</creatorcontrib><creatorcontrib>Visser, Karen</creatorcontrib><creatorcontrib>Heimans, Lotte</creatorcontrib><creatorcontrib>Ronday, H Karel</creatorcontrib><creatorcontrib>Molenaar, Esmeralda</creatorcontrib><creatorcontrib>Groenendael, J Hans L M</creatorcontrib><creatorcontrib>Peeters, André J</creatorcontrib><creatorcontrib>Westedt, Marie-Louise</creatorcontrib><creatorcontrib>Collée, Gerard</creatorcontrib><creatorcontrib>de Sonnaville, Peter B J</creatorcontrib><creatorcontrib>Grillet, Bernard A M</creatorcontrib><creatorcontrib>Huizinga, Tom W J</creatorcontrib><creatorcontrib>Allaart, Cornelia F</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wevers-de Boer, Kirsten</au><au>Visser, Karen</au><au>Heimans, Lotte</au><au>Ronday, H Karel</au><au>Molenaar, Esmeralda</au><au>Groenendael, J Hans L M</au><au>Peeters, André J</au><au>Westedt, Marie-Louise</au><au>Collée, Gerard</au><au>de Sonnaville, Peter B J</au><au>Grillet, Bernard A M</au><au>Huizinga, Tom W J</au><au>Allaart, Cornelia F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)</atitle><jtitle>Annals of the rheumatic diseases</jtitle><addtitle>Ann Rheum Dis</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>71</volume><issue>9</issue><spage>1472</spage><epage>1477</epage><pages>1472-1477</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Aim Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA). Method 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified. Results With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity. Conclusion Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and European League Against Rheumatism</pub><pmid>22402145</pmid><doi>10.1136/annrheumdis-2011-200736</doi><tpages>6</tpages></addata></record> |
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| ispartof | Annals of the rheumatic diseases, 2012-09, Vol.71 (9), p.1472-1477 |
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| subjects | Antirheumatic Agents - administration & dosage Antirheumatic Agents - therapeutic use Arthritis Arthritis - drug therapy Arthritis - pathology Biological and medical sciences Bones, joints and connective tissue. Antiinflammatory agents Classification Clinical trials Diseases of the osteoarticular system Drug Combinations Drug dosages Female HIV Human immunodeficiency virus Humans Inflammatory joint diseases Male Medical sciences Methotrexate - administration & dosage Methotrexate - therapeutic use Middle Aged Pharmacology. Drug treatments Prednisone - administration & dosage Prednisone - therapeutic use Remission Induction Rheumatology Substance abuse treatment Tuberculosis Variables |
| title | Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study) |
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