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When is it not ethical to withhold treatment for rheumatoid arthritis?
  1. Yusuf Yazici
  1. Correspondence to Dr Yusuf Yazici, NYU Hospital for Joint Diseases, 333 East 38th Street, New York, NY 10016 USA; yusuf.yazici{at}nyumc.org

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I read with interest the study by Takeuchi et al1 looking at the role of monotherapy golimumab in Japanese rheumatoid arthritis (RA) patients, who had active disease despite disease-modifying anti-rheumatic drug (DMARD) therapy. Inclusion criteria for the study stipulated that patients have two out of three criteria which were elevated inflammatory markers, erosions on radiograph or positive serology, in addition to more than six swollen and tender joints despite DMARD therapy for at least 3 months. They had mean disease duration of close to 9 years and mean swollen and tender joint counts of roughly 16 and 13. They were then randomised to placebo, golimumab 50 or golimumab 100 mg injections. Primary efficacy outcome was at 14 weeks, as the authors state “due to ethical concerns about the potential for an inadequate response to placebo”. At 14 weeks, both golimumab doses showed better efficacy than placebo. In the Introduction section, the justification for looking into monotherapy was explained as “some patients cannot …

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