Comparison of remission criteria in patients with RA treated with biologic or targeted DMARDs from a nationwide registry

Findings of a nationwide registry carried out by Korean researchers have concluded that remission rates based on simplified disease activity index (SDAI), clinical disease activity index (CDAI), or the Boolean criteria are more stringent and congruent with DAS28-based criteria in RA patients treated with biologic or targeted synthetic (b/ts) DMARDs.

The longitudinal observational analysis carried out by Koh et al.  used DAS28, CDAI, SDAI and Boolean-based assessment for defining the remission rates in KOBIO-RA registry. Yearly remission rates were assessed for 5 years for all subgroups who received treatment with b/tsDMARDs. The corresponding remission rates attained at 12th month for assessments using DAS28-C-reactive protein (CRP), DAS28-erythrocyte sedimentation rate (ESR), CDAI, SDAI and Boolean criteria were 56%, 36.2% ,10.4%, 12.7% and 12.9%. The respective sustained remission rates noted were 62%, 40%, 8%, 11%, and 13%.

In the recent years, sustained remission, as opposed to low disease activity, has emerged as the treatment target in the management of RA. The efficacy of various composite disease activity indices for detecting and documenting remission have been investigated by various studies.  Since the DAS28-based remission criteria are more sensitive to changes in acute-phase reactants, there is a possibility of distinct variations

in remission rates in subjects receiving b/tsDMARD therapies.  Hence there are chances of overestimating the remission depending on the indices and definitions used. The present study highlights the need to carefully interpret and analyze the comparisons of remission rates between b/tsDMARDs.

Reference: Koh JH, Lee Y, Kim H-A, Kim J, Shin K. Comparison of remission criteria in patients with rheumatoid arthritis treated with biologic or targeted synthetic disease modifying anti-rheumatic drugs: results from a nationwide registry. Ther Adv Musculoskel Dis. 2022, 14: 1–11.

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