Drug-Free Remission in Early Peripheral Spondyloarthritis, including Psoriatic Arthritis: 10-year follow-up from the CRESPA trial.

Abstract

To provide a descriptive analysis of the 10-year follow-up data from the CRESPA study. Here, patients fulfilling the ASAS peripheral spondyloarthritis (pSpA) classification criteria, with symptom duration ≤12 weeks, were randomized to golimumab 50mg Q4W or placebo. Our aims were to assess the proportion of patients in (drug-free) clinical remission and identify baseline predictors of achieving (drug-free) remission at 10-year follow-up. All patients from the original CRESPA study were invited for a standardized evaluation 10 years after inclusion. Clinical remission was defined as the absence of swollen joints, enthesitis or dactylitis. Of 60 original patients, 49 were evaluated after a mean of 10.5 years (SD 0.87). 81.6% (40/49) of patients were in clinical remission, of whom 30.6% (15/49) achieved longstanding drug-free remission. Remission was not linked to baseline characteristics like sex, age, HLA B27-positivity, psoriasis or initial treatment allocation. Patients without psoriasis at baseline were significantly more likely to achieve drug-free remission (OR 9.1; 95% CI 1.8-50), with 48.1% (13/27) non-psoriatic pSpA patients remaining in drug-free remission. Health-related quality of life and physical function was significantly better in patients in remission. Remission induction with golimumab in patients with early pSpA enables achievement of sustained clinical remission in the majority of patients with one-third of patients attaining drug-free remission. Strikingly, almost half of non-psoriatic pSpA remained in drug-free remission. These findings strongly suggest that early, intensive treatment has the potential to achieve long-term disease control, potentially leading to sustained drug-free remission in a subset of patients.