Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

PURPOSE OF REVIEW: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA. RECENT FINDINGS: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative “risk” was 1.73 [95%CI 1.59–1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03–1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid “bridging therapy” was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83–1.35]). For other remission outcomes, results were in line with above. SUMMARY: Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11926-019-0821-1) contains supplementary material, which is available to authorized users.