Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

“…Eleven trials [26][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48][49]51,[54][55][56][57][58][59][60]62,[64][65][66][67] examined an early RA population (defined as disease duration of < 3 years; see Chapter 4, Inclusion and exclusion criteria) [i.e. BehandelStrategieën in Reumatoïde Artritis (BeSt), 26- 55 the TreaTing to Twin Targets (T-4) study, 56,57 the Treatment of Early Aggressive Rheumatoid arthritis (TEAR) trial [58][59][60] and the early rheumatoid arthritis treated with tocilizumab, methotrexate or their combination (U-Act-Early) trial 62 ], three trials 9,50,52,53 examined an established RA population [i.e. British Rheumatoid Outcome Study Group (BROSG) trial, 9 Fransen et al 50 and the Optimisation of Adalimumab study 52,53 ] and two trials 61,63 examined populations that i...…”

“…If sustained remission was achieved, the dose of MTX was reduced stepwise by 5 mg every 4 weeks until 10 mg, then discontinued as the next step; 4 weeks thereafter, PBO-TOC was tapered to 4 mg/kg and after 3 months of 4 mg/kg per 4 weeks, PBO-TOC was discontinued, provided sustained remission persisted DAS, Disease Activity Score; DAS28-ESR, Disease Activity Score, 28 joints with erythrocyte sedimentation rate; ESR, erythrocyte sedimentation rate; ITT, intention to treat; MMP-3, matrix metalloproteinase 3; MTX-TSU, methotrexate tight step-up; PDN, prednisone; SJC28, swollen joint count, 28 joints; TNF, tumour necrosis factor; VAS, visual analogue scale. a n = 94 in Verschueren et al ); a DAS28 of < 2.6 (T-4 study 56,57 and Optimisation of Adalimumab study 52,53 ); a DAS28 of < 2.6 and a SJC (28 joints) of ≤ 4 (U-Act-Early 62 )] response [defined by thresholds of SJC, TJC, erythrocyte sedimentation rate (ESR) and general well-being visual analogue scale (VAS) (CAMERA 35,36,67 )]: and matrix metalloproteinase 3 (MMP-3) concentration (< 121 ng/ml for men or < 59.7 ng/ml for women; T-4 study 56,57 ). Treatment protocols for attaining the target varied considerably across studies in terms of the number of steps in the treatment protocol and the treatments used at each step, the only similar ones being in the COBRA Classic arms of the CareRA 40,42,43 and COBRA-light 44,45 trials (which were similar, but not exactly alike).…”

Managing rheumatic and musculoskeletal diseases — past, present and future

“…Biologicals were a nonexisting market in the 90s, but have now grown to a market well over 100 billion Euros a year 11 . In addition, starting (aggressive) treatment in inflammatory RMDs early has been widely adopted and lead to a significant gain in efficacy, and drug free remission is now becoming an attainable goal in the treatment of RA 12 . A timeline of drug development in rheumatology is presented in Figure 1.…”

Effects of psychosocial factors on monitoring treatment effect in newly diagnosed rheumatoid arthritis patients over time: response data from the tREACH study

“…This target has been proposed in guidelines as remission or low disease activity, which is commonly measured in clinical practice by composite scores such as the Disease Activity Score (DAS) and the Disease Activity Score based on 28-joint count (DAS28) (4). Recently published studies show that with this regimen a response rate of 40-80% can be reached within 1 year (5,6). Several patient and disease characteristics, such as baseline disease activity (7,8), age (7,9), and gender (7)(8)(9), have been reported that may explain part of the variability in response rates.…”