Ten years after early treatment, one in three patients with peripheral spondyloarthritis was drug-free

Design

Ten-year descriptive follow-up of a randomised trial (CRESPA)

Population

49 of 60 patients with early peripheral spondyloarthritis assessed at a mean of 10.5 years

Primary outcome

Clinical remission and drug-free remission

Effect

Remission 81.6%; drug-free remission 30.6%; no psoriasis OR 9.1 (95% CI 1.8 to 50)

CRESPA randomised patients with early peripheral spondyloarthritis, symptoms for 12 weeks or less, to golimumab 50 mg every four weeks or placebo. This descriptive ten-year follow-up invited all 60 original patients; 49 were assessed after a mean of 10.5 years.

Clinical remission, defined as no swollen joints, enthesitis or dactylitis, was present in 81.6% (40 of 49), and 30.6% (15 of 49) had longstanding drug-free remission. Remission was not linked to sex, age, HLA-B27, psoriasis or original allocation. Drug-free remission was, however, more likely in patients without psoriasis at baseline (odds ratio 9.1, 95% CI 1.8 to 50): 48.1% (13 of 27) of nonpsoriatic patients stayed drug-free. Quality of life and function were better in those in remission.

The sample is small, the interval around the odds ratio is very wide, 11 patients were lost, and the follow-up is descriptive. It suggests that early treatment may allow drug-free remission in some patients, but it cannot show which patients should try stopping.

• 81.6% of 49 assessed patients were in clinical remission at ten years.
• 30.6% were in longstanding drug-free remission.
• Drug-free remission was more likely without baseline psoriasis (OR 9.1, 95% CI 1.8 to 50).
• The odds ratio interval is very wide because only 49 patients were assessed.
• Consider a supervised drug-withdrawal attempt only in sustained remission.

Why it matters

It gives long-term data on whether early intensive treatment can lead to remission that lasts without drugs.

Don't overread it

A small descriptive follow-up of a trial cannot show who can safely stop treatment.

The statistics, in plain English

An odds ratio of 9.1 with an interval of 1.8 to 50 means the benefit of not having psoriasis could be modest or huge; with 49 patients, the data cannot say. Eleven original patients were not assessed, so those who did well may be over-represented.

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