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Open Access Highly Accessed Research article

Clinical and functional remission: even though biologics are superior to conventional DMARDs overall success rates remain low – results from RABBIT, the German biologics register

Joachim Listing1*, Anja Strangfeld1, Rolf Rau2, Jörn Kekow3, Erika Gromnica-Ihle4, Thilo Klopsch5, Winfried Demary6, Gerd-Rüdiger Burmester7 and Angela Zink17

  • * Corresponding author: Joachim Listing Listing@drfz.de

  • † Equal contributors

Author Affiliations

1 German Rheumatism Research Centre, Berlin, Germany

2 Evangelisches Fachkrankenhaus, Ratingen, Germany

3 University of Magdeburg, Magdeburg, Germany

4 Rheumaklinik Berlin-Buch, Berlin, Germany

5 Wilhelm-Kulz-Street 15, Neubrandenburg, Germany

6 Bahnhofsalle 3-4, Hildesheim, Germany

7 Charité University Hospital, Berlin, Germany

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Arthritis Research & Therapy 2006, 8:R66  doi:10.1186/ar1933

Published: 5 April 2006

Abstract

We investigated the frequency of remission according to the disease activity score (DAS28) definition, modified American Rheumatology Association (ARA) criteria, and the frequency of an achievement of a functional status above defined thresholds ('functional remission', 'physical independence') in rheumatoid arthritis (RA) patients treated with either biologics or conventional DMARDs. We used the data of a prospective cohort study, the German biologics register RABBIT (German acronym for Rheumatoid Arthritis – Observation of Biologic Therapy) to investigate the outcomes in RA patients with two or more DMARD failures who received new treatment with biologics (BIOL; n = 818) or a conventional DMARD (n = 265). Logistic regression analysis was applied to adjust for differences in baseline risks. Taking risk indicators such as previous DMARD failures or baseline clinical status into account, we found that biologics doubled the chance of remission compared to conventional DMARD therapies (DAS28 remission, adjusted odds ratio (OR) 1.95 (95% confidenece interval (CI) 1.2–3.2)); ARA remission, OR 2.05 (95% CI 1.2–3.5)). High remission rates (DAS28 remission, 30.6%; ARA remission, 16.9%) were observed in BIOL patients with a moderate disease activity (DAS28, 3.2 to 5.1) at the start of treatment. These rates decreased to 8.5% in patients with DAS28 > 6. Sustained remission at 6 and 12 months was achieved in <10% of the patients. Severely disabled patients (≤50% of full function) receiving biologic therapies were significantly more likely to achieve a status indicating physical independence (≥67% of full function) than controls (OR 3.88 (95% CI 1.7–8.8)). 'Functional remission' (≥83% of full function) was more often achieved in BIOL than in controls (OR 2.18 (95% CI 1.04–4.6)). In conclusion, our study shows that biologics increase the chance to achieve clinical remission and a status of functional remission or at least physical independence. However, temporary or even sustained remission remain ambitious aims, which are achieved in a minority of patients only.