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Correspondence response
The TRIFRA trial: efforts employed to minimise expectation bias
  1. Qian-wen Lv1,
  2. Wen Zhang1,
  3. Qun Shi1,
  4. Wen-jie Zheng1,
  5. Peter E Lipsky2,
  6. Xuan Zhang1
  1. 1Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Formerly National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Xuan Zhang, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; zxpumch2003{at}sina.com and Dr Peter E Lipsky, Formerly National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; peterlipsky@comcast.net

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We thank the readers for their interest in our manuscript reporting the comparative impact of an extract of TwHF and methotrexate, or the combination in subjects with rheumatoid arthritis.1 We completely agree with the readers that the study must be interpreted with caution because it was carried out in an open-label manner owing to cost considerations. We discussed this in detail in the section on Limitations in the Discussion of the paper. However, it is difficult to predict how patient expectation might bias the study. On the one hand, extracts of TwHF have been used for hundreds of years in China to treat various symptoms and, over the past 30 years, extracts of TwHF have become a standard therapy …

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