BeSt practice: the success of early-targeted treatment in rheumatoid arthritis.

OBJECTIVES Targeted treatment is effective in the short term in achieving low disease activity or even remission in patients with rheumatoid arthritis (RA). The benefits of long-term targeted treatment are discussed based on the BeSt study results. METHODS The BeSt study has incorporated 7 years of targeted treatment, aiming at low disease activity (DAS =<2.4), and including both treatment intensification when DAS is high and treatment tapering and discontinuation if DAS is persistently low. Functional ability over time, (drug free) remission percentages, treatment adjustments and radiological outcomes over 7 years are discussed. RESULTS Targeted treatment resulted in stabilisation of functional ability after initial improvement, minimal radiological damage progression after the first year, and tapering of medication. Drug free remission was achieved in 15% of completers in year 7. Patients who lost drug free remission (46% up to year 5) restarted treatment and mostly regained remission without radiological deterioration. Patients treated with initial combination therapy responded earlier and had less damage progression that remained evident up to five years follow up. CONCLUSIONS Early and maintained targeted treatment has functional and radiological benefits over the first 7 years of the BeSt study and can include drug tapering and (partial, temporary or permanent) discontinuation.