Long Term Study Shows Early, Intensive RA Intervention Valuable

A 23-year follow-up study presented at the 2018 Annual European Congress of Rheumatology (EULAR 2018) found that early, intensive rheumatoid arthritis (RA) intervention with combination therapy demonstrated long term benefits and reduced mortality.

“Our results confirm that early, intensive treatment of rheumatoid arthritis, including use of glucocorticoids, has long-term benefits,” Maarten Boers, MD, PhD, MSc, of the VU University Medical Center in Amsterdam, said in a press release. “Importantly, this study is one of the first to show a normalization of RA mortality compared to the general population after 23 years of follow-up.”

The researchers sought to understand how COBRA combination therapy (sulfasalazine, low-dose methotrexate, and initially high, step-down prednisolone) impacted mortality rates among patients with RA over the 23-year study period.

“Mortality in patients with rheumatoid arthritis (RA) is higher than the general population,” the researchers wrote. “Most cohorts show that the adverse effect of RA becomes apparent only after more than a decade of follow up.”

They compared data from155 patients, including 79 patients treated with sulfasalazine monotherapy and 76 patients treated with COBRA therapy. 

Study results showed that the mortality rate was not statistically different between the two early intervention groups, with 28% in the COBRA group and 30% in the sulfasalazine group. Additionally, the researcher found that in a control sample of patients from the general population, the mortality rate was 36%.

“This trial population had a numerically lower mortality than expected,” the researchers concluded. “This confirms that early, intensive treatment of RA (that can include glucocorticoids) has long-term benefits, and strongly suggests these benefits include normalization of mortality.”