BeSt: Benefits of Treat-to-Target Persist at 8 Years

BERLIN – The observed initial improvement in functional ability seen with treat-to-target strategies for rheumatoid arthritis patients in the BeSt trial was maintained at 8-year follow-up, according to findings presented at the annual European Congress of Rheumatology.

"At year 8, we found stable good functional ability for all treatment groups, and low disease activity in 79% of patients. And even though treatment was aimed at low disease activity, we found a stable remission percentage of 52%," said Dr. Marianne van den Broek of Leiden University Medical Centre, the Netherlands.

Participants in the multicenter, randomized, single-blind Behandel Strategieën trial (BeSt) included 508 adults with recent onset RA. They were randomized to one of four treatment strategies, including sequential monotherapy, step-up combination therapy, initial combination therapy with prednisone, or initial combination with infliximab. All treatment arms aimed for a disease activity score smaller than or equal to 2.4, indicating low disease activity. Behandel Strategieën is Dutch for treatment strategies, she said.

"After 1 year, we found that patients from the two initial combination therapy groups showed earlier improvement of disease activity and functional ability and less radiological damage progression than the two initial monotherapy groups," Dr. van den Broek explained.

From year 3, patients who had been in remission – defined as a DAS of less than 1.6 – for at least 6 months on a maintenance dose of either methotrexate or sulfasalazine monotherapy could taper their disease-modifying antirheumatic drug until they were drug free, she added.

In the follow-up phase, between 15% and 18% of the 347 patients who remained in the study were in drug-free remission at 8 years, depending on their treatment arm, with a median remission duration of 45 months and a mean duration of 39 months, she said.

Radiological damage progression was minimal in the entire follow-up study population.

Also, despite differences in outcomes between the four treatment arms at the end of the initial BeSt study period, those differences were no longer significant at the end of follow-up.

"The fact that the initial differences between the initial treatment groups are no longer found at 8-year follow-up confirms the importance of treatment to target, which is now the mainstay of EULAR recommendations for the management of patients with RA," Dr. van den Broek said.

Furthermore, BeSt is one of few studies in which tapering to drug free was incorporated in the protocol, she added.

"We have shown that, with early initiation of targeted treatment, almost 20% of patients can maintain remission without using any DMARD, for a prolonged period [median duration, 45 months]," she said.

The findings are also important because they demonstrate the overall long-term benefits of treat-to-target strategies.

"With our 8-year follow-up data in this large treat-to-target cohort, we show that long-term treating to target is possible. It is beneficial not only in the early stages of RA when disease is usually most active, but also during follow-up," she said.

Dr. van den Broek reported that she had no relevant financial conflicts of interest.

BERLIN – The observed initial improvement in functional ability seen with treat-to-target strategies for rheumatoid arthritis patients in the BeSt trial was maintained at 8-year follow-up, according to findings presented at the annual European Congress of Rheumatology.

"At year 8, we found stable good functional ability for all treatment groups, and low disease activity in 79% of patients. And even though treatment was aimed at low disease activity, we found a stable remission percentage of 52%," said Dr. Marianne van den Broek of Leiden University Medical Centre, the Netherlands.

Participants in the multicenter, randomized, single-blind Behandel Strategieën trial (BeSt) included 508 adults with recent onset RA. They were randomized to one of four treatment strategies, including sequential monotherapy, step-up combination therapy, initial combination therapy with prednisone, or initial combination with infliximab. All treatment arms aimed for a disease activity score smaller than or equal to 2.4, indicating low disease activity. Behandel Strategieën is Dutch for treatment strategies, she said.

"After 1 year, we found that patients from the two initial combination therapy groups showed earlier improvement of disease activity and functional ability and less radiological damage progression than the two initial monotherapy groups," Dr. van den Broek explained.

From year 3, patients who had been in remission – defined as a DAS of less than 1.6 – for at least 6 months on a maintenance dose of either methotrexate or sulfasalazine monotherapy could taper their disease-modifying antirheumatic drug until they were drug free, she added.

In the follow-up phase, between 15% and 18% of the 347 patients who remained in the study were in drug-free remission at 8 years, depending on their treatment arm, with a median remission duration of 45 months and a mean duration of 39 months, she said.

Radiological damage progression was minimal in the entire follow-up study population.

Also, despite differences in outcomes between the four treatment arms at the end of the initial BeSt study period, those differences were no longer significant at the end of follow-up.

"The fact that the initial differences between the initial treatment groups are no longer found at 8-year follow-up confirms the importance of treatment to target, which is now the mainstay of EULAR recommendations for the management of patients with RA," Dr. van den Broek said.

Furthermore, BeSt is one of few studies in which tapering to drug free was incorporated in the protocol, she added.

"We have shown that, with early initiation of targeted treatment, almost 20% of patients can maintain remission without using any DMARD, for a prolonged period [median duration, 45 months]," she said.

The findings are also important because they demonstrate the overall long-term benefits of treat-to-target strategies.

"With our 8-year follow-up data in this large treat-to-target cohort, we show that long-term treating to target is possible. It is beneficial not only in the early stages of RA when disease is usually most active, but also during follow-up," she said.

Dr. van den Broek reported that she had no relevant financial conflicts of interest.

BERLIN – The observed initial improvement in functional ability seen with treat-to-target strategies for rheumatoid arthritis patients in the BeSt trial was maintained at 8-year follow-up, according to findings presented at the annual European Congress of Rheumatology.

"At year 8, we found stable good functional ability for all treatment groups, and low disease activity in 79% of patients. And even though treatment was aimed at low disease activity, we found a stable remission percentage of 52%," said Dr. Marianne van den Broek of Leiden University Medical Centre, the Netherlands.

Participants in the multicenter, randomized, single-blind Behandel Strategieën trial (BeSt) included 508 adults with recent onset RA. They were randomized to one of four treatment strategies, including sequential monotherapy, step-up combination therapy, initial combination therapy with prednisone, or initial combination with infliximab. All treatment arms aimed for a disease activity score smaller than or equal to 2.4, indicating low disease activity. Behandel Strategieën is Dutch for treatment strategies, she said.

"After 1 year, we found that patients from the two initial combination therapy groups showed earlier improvement of disease activity and functional ability and less radiological damage progression than the two initial monotherapy groups," Dr. van den Broek explained.

From year 3, patients who had been in remission – defined as a DAS of less than 1.6 – for at least 6 months on a maintenance dose of either methotrexate or sulfasalazine monotherapy could taper their disease-modifying antirheumatic drug until they were drug free, she added.

In the follow-up phase, between 15% and 18% of the 347 patients who remained in the study were in drug-free remission at 8 years, depending on their treatment arm, with a median remission duration of 45 months and a mean duration of 39 months, she said.

Radiological damage progression was minimal in the entire follow-up study population.

Also, despite differences in outcomes between the four treatment arms at the end of the initial BeSt study period, those differences were no longer significant at the end of follow-up.

"The fact that the initial differences between the initial treatment groups are no longer found at 8-year follow-up confirms the importance of treatment to target, which is now the mainstay of EULAR recommendations for the management of patients with RA," Dr. van den Broek said.

Furthermore, BeSt is one of few studies in which tapering to drug free was incorporated in the protocol, she added.

"We have shown that, with early initiation of targeted treatment, almost 20% of patients can maintain remission without using any DMARD, for a prolonged period [median duration, 45 months]," she said.

The findings are also important because they demonstrate the overall long-term benefits of treat-to-target strategies.

"With our 8-year follow-up data in this large treat-to-target cohort, we show that long-term treating to target is possible. It is beneficial not only in the early stages of RA when disease is usually most active, but also during follow-up," she said.

Dr. van den Broek reported that she had no relevant financial conflicts of interest.