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Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis

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Abstract

This systematic review and meta-analysis aim to evaluate the remission rate of patients with rheumatoid arthritis (RA) in real-world studies and to summarize potential predictors of remission in RA. Studies reporting remission rate in patients with RA were searched from MEDLINE, EMBASE, and Scopus databases. Two reviewers independently assessed all studies according to eligibility criteria and extracted data. Generally, observational studies reporting remission rate in adult (≥ 18 years) patients with RA were included. Quality assessments were performed using the Newcastle-Ottawa Scale. Pooled analyses of remission rate were conducted using a random-effects model and data were analyzed in subgroups to identify potential source of heterogeneity. Sensitivity analyses were performed by serially excluding each study. Potential predictors of remission were summarized. Thirty-one studies with ~ 82,450 RA patients in total were included. Using the DAS28 remission criteria, the pooled 3-, 6-, 12-, and 24-month remission rates were 17.2%, 16.3%, 21.5%, and 23.5%, respectively. Subgroup analyses showed that 11.7% and 13.8% of TNFi inadequate responders reached remission after 6- and 12-month use of non-TNFi biologics. Predictors of remission included male, higher education level, and lower baseline disease activity, while initial use of corticosteroids was negative predictors of remission. Sustained remission was rare regardless of different criteria used. Remission was a reachable target in real-world studies, while attention should also be paid to achieve sustained remission.

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Funding

This study was supported by the Chinese National Key Technology R&D Program (2017YFC0907601, 2017YFC0907604).

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Author notes

  1. Chen Yu and Shangyi Jin contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China

    Chen Yu, Shangyi Jin, Nan Jiang, Chanyuan Wu, Qian Wang, Xinping Tian, Mengtao Li & Xiaofeng Zeng

  2. Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China

    Yanhong Wang

  3. Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China

    Mengtao Li & Xiaofeng Zeng

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  1. Chen Yu
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Contributions

CY, SYJ, YHW, and MTL designed the study and discussed on the search terms. CY and SYJ independently identified the search, reviewed the titles and abstracts, retrieved full articles to determine eligibility of each study, and extracted data from selected articles using a standardized form. Discrepancies were resolved at each step by consensus with a third reviewer (YHW). CY drafted the manuscript. NJ, CYW, QW, XPT, and XFZ revised the manuscript critically.

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Correspondence to Mengtao Li or Xiaofeng Zeng.

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Yu, C., Jin, S., Wang, Y. et al. Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis. Clin Rheumatol 38, 727–738 (2019). https://doi.org/10.1007/s10067-018-4340-7

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