Remission versus low disease activity as treatment targets in rheumatoid arthritis: how to strike the right balance between too strict and too lenient targets? A meta-epidemiological study of individual patient data
Authors' conclusion
SDAI-LDA is associated with more structural damage over 2 years than any of the definitions of remission. It also allows substantial disease impact to go unchecked and uncontrolled.
Study context
- Population
- Patients with established RA in eight RCTs
- Participants
- 4,374 patients8 RCTs
- Comparison
- SDAI-LDA vs different definitions of remission (SDAI-Remission, 4V-Remission, 3V-Remission) as treatment target at 6 months
- Outcome
- Mean radiographic change in mTSS and Good Radiographic Outcome rates (change of ≤0.5 units mTSS) compared among target definitions
- Follow-up
- 2 years
Methodological details8 RCTs
- 8 RCTs
Pooled result
As reported in the abstract
Mean radiographic progression (mTSS)
SDAI-LDA
0.55
mean · CI 0.14–0.96 · units
SDAI-Remission
0.22
mean · CI −0.09–0.54
4V-Remission
0.28
mean · CI −0.07–0.62
3V-Remission
0.28
mean · CI −0.10–0.65
Further pooled results
| Outcome | Values | P value |
|---|---|---|
| Mean radiographic progression, SDAI Pure-LDA vs SDAI-RemissionSignificantly more radiographic progression | SDAI Pure-LDA mean 0.72 units | P < 0.05 |
| Mean radiographic progression, SDAI-LDA not in 3V-Remission vs both targets met · 2 years | SDAI-LDA not in 3V-Remission mean 0.70 units · Both targets met mean 0.25 units | P = 0.014 |
| Target attainment at 6 months (pooled rate) | SDAI-LDA 49% · SDAI-Remission 13% · 4V-Remission 16% · 3V-Remission 23% | |
| PGA>2 among SDAI-LDA but not SDAI-RemissionReflecting relevant disease impact | SDAI Pure-LDA 40% |
- Mean radiographic progression, SDAI-LDA not in 3V-Remission vs both targets met — SDAI-LDA patients not in 3V-Remission
- Over 53%
Original publication
Remission versus low disease activity as treatment targets in rheumatoid arthritis: how to strike the right balance between too strict and too lenient targets? A meta-epidemiological study of individual patient data. RMD Open. Published 7 November 2024. doi:10.
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