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The following is a summary of “Long-term clinical outcomes in early rheumatoid arthritis that was treated-to-target in the BeSt and IMPROVED studies,” published in the April 2024 issue of Rheumatology by Heckert et al.

Researchers conducted a retrospective study to assess disease outcomes after 20 and 12 years of patients with rheumatoid (RA) or undifferentiated arthritis (UA). 

They used BeSt and IMPROVED trials to determine the disease outcome. In BeSt 508 patients with early RA were included between 2000-2002, lasting 10 years, where the treatment target was low disease activity (DAS ≤2.4). In an IMPROVED trial, 610 patients with early RA/UA who started MTX with prednisone bridging were included during 2007-2010, lasting five years, where the target was remission (DAS<1.6). All patients were randomized to one therapy: sequential monotherapy, step-up combination therapy, initial csDMARD combination therapy, or bDMARD/csDMARD combination therapy. Later, in 2019-2022, these patients were invited for a long-term follow-up.  

The results showed that 153 ex-BeSt and 282 ex-IMPROVED patients participated in the follow-up study after a median of 12 and 20 years since the start of the study. In ex-BeSt and ex-IMPROVED patients, the rate of low disease activity was 91%, and the same was 68% in DAS remission. Median SHS was 14.0 (IQR 6.0–32.5) in ex-BeSt, with progression since the end of BeSt at 6.0 (IQR 2.0–12.5), and 8 (IQR 3–16) in ex-IMPROVED, with progression since end IMPROVED at 4 (IQR 2–9). Mean HAQ was 0.8 ± 0.6 in ex-BeSt, with change since end BeSt at 0.3 ± 0.5, and 0.6 ± 0.6 in ex-IMPROVED, with change since end IMPROVED at 0.06 ± 0.5.

Investigators concluded that after 12/20 years of treatment start, the majority of RA and UA patients were in DAS remission and had limited functional disability along with mild radiographic damage progression. 

Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keae212/7638805