Maxime Verhoeven

20 Chapter 2 ABSTRACT Purpose of review To review the effectiveness of remission-induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA. Recent findings Twenty-nine studies, heterogeneous on e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission-induction strategies showed significantly more patients achieving remission. Pooled relative ‘risk’ was 1.73 [95%CI 1.59-1.88] for (b)iological DMARD based remission- induction strategies, and 1.20 [95%CI 1.03-1.40] for combination csDMARD based remission-induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid ‘bridging therapy’ was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission-induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Summary Remission-induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.