Early Golimumab Therapy May Enable Long-Term Drug-Free Remission in Peripheral Spondyloarthritis: Study
Belgium: Researchers have found in a 10-year follow-up of patients with newly diagnosed peripheral spondyloarthritis (pSpA) that early treatment with golimumab was associated with sustained drug-free remission in a significant proportion of patients. Notably, about half of those without psoriasis at baseline or during follow-up achieved long-term remission, supporting further evaluation of early aggressive biologic therapy in newly diagnosed pSpA.
The long-term findings come from the CRESPA trial and were published in Arthritis & Rheumatology by Caroline Damen, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium, and colleagues. The study examined whether early disease control achieved with golimumab could translate into lasting remission years after treatment.
Peripheral spondyloarthritis is an inflammatory rheumatic disease that can involve peripheral joints, entheses and digits. The potential for early intervention to alter the long-term course of the disease has generated considerable clinical interest.
The original CRESPA trial enrolled patients who fulfilled the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for pSpA and had experienced symptoms for no more than 12 weeks. Participants were randomly assigned to receive golimumab 50 mg every four weeks or placebo. For the 10-year assessment, all participants from the original trial were invited for a standardized clinical evaluation.
Clinical remission was defined as having no swollen joints, enthesitis, or dactylitis. Of the 60 patients originally enrolled, 49 completed the long-term evaluation after a mean follow-up of 10.5 years.
The key findings were:
- 81.6% of evaluated patients (40/49) were in clinical remission at the 10-year assessment.
- 30.6% (15/49) achieved longstanding remission without ongoing drug treatment.
- Baseline sex, age, HLA-B27 status, psoriasis, and initial treatment assignment were not significantly associated with remission at 10 years.
- Patients without psoriasis at baseline were significantly more likely to achieve drug-free remission (OR 9.1; 95% CI 1.8–50).
- Among patients without psoriasis, 48.1% (13/27) remained in drug-free remission.
- Patients who remained in remission had significantly better health-related quality of life and physical functioning.
The researchers noted that nearly one-third of patients achieved sustained drug-free remission over the long term, while most participants remained in clinical remission at 10 years. The particularly high proportion of non-psoriatic patients maintaining remission suggests that disease phenotype may be relevant when considering long-term outcomes.
The study concluded that early remission induction with golimumab may facilitate prolonged disease control in newly diagnosed pSpA, with a subset of patients eventually maintaining remission without medication. The authors emphasized that these findings support further investigation of early intensive treatment strategies and factors that may identify patients most likely to achieve durable drug-free remission.
Reference:
Damen, C., Craemer, A. S. D., Webers, C., Elewaut, D., Varkas, G., & Carron, P. Drug-Free Remission in Early Peripheral Spondyloarthritis, including Psoriatic Arthritis: 10-year follow-up from the CRESPA trial. Arthritis & Rheumatology. https://doi.org/10.1002/art.70349
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