Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

Area of Science:

• Rheumatology
• Clinical Immunology
• Pharmacology

Background:

• Early rheumatoid arthritis (RA) management aims for remission.
• Current guidelines recommend various treatment strategies.
• Comparing remission induction versus single csDMARD initiation is crucial.

Purpose of the Study:

• To systematically review the efficacy of remission induction strategies versus single csDMARD initiation in early RA.
• To compare different types of induction strategies, including bDMARD-based and csDMARD-based approaches.

Main Methods:

• Systematic review of 29 heterogeneous studies.
• Analysis of remission rates using DAS28-remission over 12 months.
• Meta-analysis of pooled relative risks (RR) for achieving remission.

Main Results:

• 13 of 17 remission induction strategies significantly improved remission rates compared to single csDMARD initiation.
• bDMARD-based induction strategies showed a pooled RR of 1.73.
• Combination csDMARD strategies showed a pooled RR of 1.20.
• The significant advantage of induction strategies was lost when single csDMARD initiation included glucocorticoid bridging therapy (RR 1.06).

Conclusions:

• Remission induction strategies are generally more effective than single csDMARD initiation for early RA.
• bDMARD-based induction strategies appear particularly potent.
• The addition of glucocorticoid bridging therapy to single csDMARD initiation may negate the superiority of induction strategies.