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The value of early intervention in RA—a window of opportunity

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Abstract

Rheumatoid arthritis (RA) is associated with progressive joint destruction, with functional status influenced by both disease activity and radiographic progression. The case for early aggressive treatment of RA is based on large amounts of good data in many countries. Studies with conventional disease-modifying anti-rheumatic drugs in early RA have shown improved outcomes compared with later treatment, especially if an aggressive approach with combinations of drugs is used. Early intervention with tumour necrosis factor (TNF) inhibitors has been shown to improve clinical outcomes, induce remission and prevent radiographic progression. It also improves patients’ functional status, health-related quality of life, and reduces fatigue. Patients with RA have reduced productivity, an increased number of lost work days and retire early; enabling patients to work should be at the core of a therapy’s cost-effectiveness. Introduction of anti-TNF therapy early in RA has been shown to decrease job loss and reduce the amount of working time missed. Although the drug costs of initial treatment with combination therapy including a TNF inhibitor are high, these may be compensated by the reduction in lost productivity, making such a strategy cost-effective overall. In addition, some patients who respond well to combination therapy may be able to stop the TNF inhibitor. It is important to assess the benefits of any intervention not just to healthcare costs but to society as a whole, and physicians should be advocates for optimal access to effective therapies for their patients.

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References

  1. Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM (1999) Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum 42:1854–1860

    Article  PubMed  CAS  Google Scholar 

  2. van Aken J, Lard LR, le Cessie S, Hazes JM, Breedveld FC, Huizinga TW (2004) Radiological outcome after 4 years of early vs delayed treatment strategy in patients with recent onset rheumatoid arthritis. Ann Rheum Dis 63:274–279

    Article  PubMed  Google Scholar 

  3. Cush JJ (2007) Early rheumatoid arthritis—is there a window of opportunity? J Rheumatol Suppl 80:1–7

    PubMed  CAS  Google Scholar 

  4. Benhamou M, Rincheval N, Roy C, Foltz V, Rozenberg S, Sibilia J et al (2009) The gap between practice and guidelines in the choice of first-line disease modifying antirheumatic drug in early rheumatoid arthritis: results from the ESPOIR cohort. J Rheumatol 36:934–942

    Article  PubMed  Google Scholar 

  5. Emery P, McInnes IB, van Vollenhoven R, Kraan MC (2008) Clinical identification and treatment of a rapidly progressing disease state in patients with rheumatoid arthritis. Rheumatology 47:392–398

    Article  PubMed  CAS  Google Scholar 

  6. Emery P (2002) Magnetic resonance imaging: opportunities for rheumatoid arthritis disease assessment and monitoring long-term treatment outcomes. Arthritis Res 4(Suppl 2):S6–S10

    Article  PubMed  Google Scholar 

  7. Anderson JJ, Wells G, Verhoeven AC, Felson DT (2000) Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 43:22–29

    Article  PubMed  CAS  Google Scholar 

  8. Möttönen T, Hannonen P, Korpela M, Nissilä M, Kautiainen H, Ilonen J et al (2002) Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 46:894–898

    Article  PubMed  Google Scholar 

  9. Aletaha D, Smolen J, Ward MM (2006) Measuring function in rheumatoid arthritis: identifying reversible and irreversible components. Arthritis Rheum 54:2784–2792

    Article  PubMed  Google Scholar 

  10. Green M, Marzo-Ortega H, McGonagle D, Wakefield R, Proudman S, Conaghan P, Gooi J, Emery P (1999) Persistence of mild, early inflammatory arthritis: the importance of disease duration, rheumatoid factor, and the shared epitope. Arthritis Rheum 42:2184–2188

    Article  PubMed  CAS  Google Scholar 

  11. Finckh A, Liang MH, van Herckenrode CM, de Pablo P (2006) Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Rheum 55:864–872

    Article  PubMed  Google Scholar 

  12. Mottonen T, Hannonen P, Leirisalo-Repo M, Nissila M, Kautiainen H, Korpela M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomized trial. Lancet 353:1568–1573

    Article  PubMed  CAS  Google Scholar 

  13. Korpela M, Laasonen L, Hannonen P, Kautiainen H, Leirisalo-Repo M, Hakala M et al (2004) Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: five-year experience from the FIN-RACo study. Arthritis Rheum 50:2072–2081

    Article  PubMed  CAS  Google Scholar 

  14. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG et al (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967

    Article  PubMed  CAS  Google Scholar 

  15. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, Singh A, Pedersen RD, Koenig AS, Freundlich B (2008) Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate-to-severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet 372:375–382

    Article  PubMed  CAS  Google Scholar 

  16. Genovese MC, Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH et al (2002) Etanercept vs methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum 46:1443–1450

    Article  PubMed  CAS  Google Scholar 

  17. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R et al (2006) The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate vs methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 54:26–37

    Article  PubMed  CAS  Google Scholar 

  18. Emery P, Genovese MC, van Vollenhoven R, Sharp JT, Patra K, Sasso EH (2009) Less radiographic progression with adalimumab plus methotrexate vs methotrexate monotherapy across the spectrum of clinical response in early rheumatoid arthritis. J Rheumatol 36:1429–1441

    Article  PubMed  CAS  Google Scholar 

  19. Allaart CF, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Breedveld FC, Dijkmans BA, FARR Study Group (2006) Aiming at low disease activity in rheumatoid arthritis with initial combination therapy or initial monotherapy strategies: the BeSt study. Clin Exp Rheumatol 24(6 Suppl 43):S-77–S-82

    Google Scholar 

  20. Kekow J, Moots RJ, Emery P, Durez P, Koenig A, Singh A et al (2010) Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trial. Ann Rheum Dis 69:222–225

    Article  PubMed  CAS  Google Scholar 

  21. Yount S, Sorensen MV, Cella D, Sengupta N, Grober J, Chartash EK (2007) Adalimumab plus methotrexate or standard therapy is more effective than methotrexate or standard therapies alone in the treatment of fatigue in patients with active, inadequately treated rheumatoid arthritis. Clin Exp Rheumatol 25:838–846

    PubMed  CAS  Google Scholar 

  22. Kimel M, Cifaldi M, Chen N, Revicki D (2008) Adalimumab plus methotrexate improved SF-36 scores and reduced the effect of rheumatoid arthritis (RA) on work activity for patients with early RA. J Rheumatol 35:206–215

    PubMed  CAS  Google Scholar 

  23. National Institute for Health and Clinical Excellence (2007) Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis. NICE, London

    Google Scholar 

  24. Burton W, Morrison A, Maclean R, Ruderman E (2006) Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 56:18–27

    Article  Google Scholar 

  25. Puolakka K, Kautiainen H, Pekurinen M, Möttönen T, Hannonen P, Korpela M et al (2006) Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients’ sickness absence and gross income: experience from the FIN-RACo trial. Ann Rheum Dis 65:899–904

    Article  PubMed  CAS  Google Scholar 

  26. Lacaille D (2005) Arthritis and employment research: where are we? Where do we need to go? J Rheumatol Suppl 72:42–45

    PubMed  Google Scholar 

  27. Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Hakala M et al (2005) Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis: five-year experience from the FIN-RACo trial. Arthritis Rheum 52:36–41

    Article  PubMed  Google Scholar 

  28. Eberhardt K, Larsson BM, Nived K, Lindqvist E (2007) Work disability in rheumatoid arthritis—development over 15 years and evaluation of predictive factors over time. J Rheumatol 34:481–487

    PubMed  Google Scholar 

  29. Bejarano V, Quinn M, Conaghan PG, Reece R, Keenan AM, Walker D et al (2008) Effect of the early use of the anti-tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis. Arthritis Rheum 59:1467–1474

    Article  PubMed  Google Scholar 

  30. Mazonson P, Globe D, Santas C, Murphy R, Cheng A, Huang X et al (2008) Assessing the impact of etanercept treatment on productivity: results from a recent RA patient work loss and productivity survey. Ann Rheum Dis 67(Suppl II):646

    Google Scholar 

  31. Anis A, Zhang W, Emery P, Sun H, Singh A, Freundlich B, Sato R (2009) The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology 48:1283–1289

    Article  PubMed  Google Scholar 

  32. Augustsson J, Neovius M, Cullinane-Carli C, Eksborg S, van Vollenhoven RF (2010) Patients with rheumatoid arthritis treated with tumour necrosis factor antagonists increase their participation in the workforce: potential for significant long-term indirect cost gains (data from a population-based registry). Ann Rheum Dis 69:126–131

    Article  PubMed  CAS  Google Scholar 

  33. Tanaka Y, Takeuchi T, Mimori T, Miyasaka N, Koike T (2009) Discontinuation of infliximab therapy is possible after acquiring remission in patients with rheumatoid arthritis (RA): first report on RRR (remission induction by remicade in RA) study. Ann Rheum Dis 68(Suppl 3):120

    Google Scholar 

  34. Saleem B, Nizam S, Emery P (2006) Can remission be maintained with or without further drug therapy in rheumatoid arthritis? Clin Exp Rheumatol 24(Suppl 43):S-33–S-36

    Google Scholar 

  35. Fautrel B, Pham T, Mouterde G, Le Loët X, Goupille P, Guillemin F et al (2007) Recommendations of the French Society for Rheumatology regarding TNFalpha antagonist therapy in patients with rheumatoid arthritis. Joint Bone Spine 74:627–637

    Article  PubMed  CAS  Google Scholar 

  36. van den Hout WB, Goekoop-Ruiterman YP, Allaart CF, de Vries-Bouwstra JK, Hazes JM, Kerstens PJ et al (2009) Cost-utility analysis of treatment strategies in patients with recent-onset rheumatoid arthritis. Arthritis Rheum 61:291–299

    Article  PubMed  Google Scholar 

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Conflict of interest

The content of this article is the sole responsibility of the author. Medical writing assistance for the preparation of this article was provided by Synergy who received financial support from Pfizer. F. Breedveld has received honoraria from Abbott and Pfizer for speaking and consulting.

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  1. Department of Rheumatology, Leiden University Medical Center, C4R, PO Box 9600, 2300RC, Leiden, The Netherlands

    Ferdinand Breedveld

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  1. Ferdinand Breedveld
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Correspondence to Ferdinand Breedveld.

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Breedveld, F. The value of early intervention in RA—a window of opportunity. Clin Rheumatol 30 (Suppl 1), 33–39 (2011). https://doi.org/10.1007/s10067-010-1638-5

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