Long-Term Follow-Up Confirms Benefits of Treat-to-Target Strategy in Early RA and UA
Two decades after initiating treatment, the majority of patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) treated using a treat-to-target approach remain in disease remission or low disease activity, according to long-term data from the BeSt and IMPROVED trials published in Rheumatology.
The follow-up study included 153 former BeSt participants (median 20 years post-enrollment) and 282 former IMPROVED participants (median 12 years post-enrollment). The treat-to-target strategies employed in the original studies aimed for low disease activity (BeSt: DAS ≤2.4) or remission (IMPROVED: DAS <1.6), using sequential, step-up, or initial combination therapy with conventional and/or biologic DMARDs.
At follow-up, 91% of participants across both cohorts had low disease activity, and 68% were in DAS remission. Functional outcomes were also favorable. The mean Health Assessment Questionnaire (HAQ) score was 0.8 ± 0.6 in the ex-BeSt group and 0.6 ± 0.6 in the ex-IMPROVED group, with minimal deterioration since the end of the original trials.
Radiographic damage, assessed by the Sharp/van der Heijde score (SHS), remained modest. The median SHS was 14.0 (IQR 6.0–32.5) in BeSt participants and 8.0 (IQR 3–16) in IMPROVED participants. While progression occurred—median increases of 6.0 and 4.0 points, respectively—overall joint damage was limited.
“Radiographic damage progression was mild although not completely suppressed,” the authors reported. “At 12/20 years after treatment started, the majority of RA and UA patients who had been treated to target low DAS or DAS remission were in DAS remission and had limited functional disability.”
These findings support the long-term effectiveness of early treat-to-target strategies in managing RA and UA, with sustained control of disease activity and preservation of physical function.
Reference
Heckert SL, Maassen JM, Nevins I, et al. Long-term clinical outcomes in early rheumatoid arthritis that was treated-to-target in the BeSt and IMPROVED studies. Rheumatology (Oxford). 2025;64(3):1052-1059. doi:10.1093/rheumatology/keae212
