Time to stop fooling ourselves over RA remission criteria

Tuesday, 12 Jul 2016

The scientific community needs to stop using the word ‘remission’ in RA study publications to refer to definitions other than the agreed ACR/EULAR criteria, an expert says.

In a letter published in the Annals of Rheumatic Diseases this week Dr Maarten Boers from the Amsterdam Rheumatology and Immunology Centre said he took issue with the chosen endpoint of ‘sustained remission’, that is, a DAS28<2.6 at weeks 40 and 52 in the recently published C-EARLY trial.

The ACR/EULAR remission criteria for RA were published before the study protocol of the C-EARLY trial was designed. Furthermore, the authors of the trial – Paul Emery, Dan Furst and Desiree van der Heijde – were clearly aware of the criteria given they were co-authors.

“There was no scientific reason NOT to use the new criteria to define the primary endpoint,” said Dr Boers in the letter titled: ‘Let’s stop fooling ourselves. In RA, only ACR/EULAR criteria define remission and equate with absence of disease!’

Instead, he said there was a pragmatic reason: the new criteria try to define true remission, or absence of disease, which is difficult to achieve, whereas DAS28 <2.6 is easier to achieve, but does NOT represent absence of disease.

“In my view a very nice study was unnecessarily diminished by this unscientific definition of the primary endpoint,” he concluded.


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