Drug‐Free Remission in Early Peripheral Spondyloarthritis, including Psoriatic Arthritis: 10‐year follow‐up from the CRESPA trial

OBJECTIVES: To provide a descriptive analysis of the 10-year follow-up data from the CRESPA study. Here, patients fulfilling the ASAS peripheral spondyloarthritis (pSpA) classification criteria, with symptom duration ≤12 weeks, were randomized to golimumab 50mg Q4W or placebo. Our aims were to assess the proportion of patients in (drug-free) clinical remission and identify baseline predictors of achieving (drug-free) remission at 10-year follow-up. METHODS: All patients from the original CRESPA study were invited for a standardized evaluation 10 years after inclusion. Clinical remission was defined as the absence of swollen joints, enthesitis or dactylitis. RESULTS: Of 60 original patients, 49 were evaluated after a mean of 10.5 years (SD 0.87). 81.6% (40/49) of patients were in clinical remission, of whom 30.6% (15/49) achieved longstanding drug-free remission. Remission was not linked to baseline characteristics like sex, age, HLA B27-positivity, psoriasis or initial treatment allocation. Patients without psoriasis at baseline were significantly more likely to achieve drug-free remission (OR 9.1; 95% CI 1.8-50), with 48.1% (13/27) non-psoriatic pSpA patients remaining in drug-free remission. Health-related quality of life and physical function was significantly better in patients in remission. CONCLUSION: Remission induction with golimumab in patients with early pSpA enables achievement of sustained clinical remission in the majority of patients with one-third of patients attaining drug-free remission. Strikingly, almost half of non-psoriatic pSpA remained in drug-free remission. These findings strongly suggest that early, intensive treatment has the potential to achieve long-term disease control, potentially leading to sustained drug-free remission in a subset of patients.