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  • Comparison of initial versus delayed introduction of a treat-to-target strategy in patients with recent-onset rheumatoid arthritis: results of the T-4 3-year study

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Comparison of initial versus delayed introduction of a treat-to-target strategy in patients with recent-onset rheumatoid arthritis: results of the T-4 3-year study
  1. Yukitomo Urata1,
  2. Yoshihide Nakamura2,
  3. Ken-ichi Furukawa3
  1. 1 Department of Rheumatology, Seihoku Central Hospital United Municipalities of Tsugaru, Gosyogawara, Aomori, Japan
  2. 2 Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
  3. 3 Department of Pharmacology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
  1. Correspondence to Dr Yukitomo Urata, Department of Rheumatology, Seihoku Central Hospital United Municipalities of Tsugaru, 41 Nunoyacho, Gosyogawara, Aomori 037-0053, Japan; yurata{at}dream.com

http://dx.doi.org/10.1136/annrheumdis-2013-203748

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    We investigated whether a delayed treat-to-target strategy introduction was disadvantageous compared with the clinical, radiological, and functional efficacy of initial introduction on early rheumatoid arthritis (RA) after a 3-year follow-up (T-4 3-year) study.

    Between August 2008 and April 2010, 243 early RA patients (symptom duration <3 years) were randomly allocated to one of four strategy groups; we focus here on the routine care (R group) and the disease activity score in 28 joints (DAS28)1 plus matrix metalloproteinase (MMP)-3-driven therapy (T group)2 (figure 1).3 The T-4 3-year study followed a 1-year study. At 56 weeks, all subjects were allocated to the T group (R→T, RT group; T→T, TT group, etc.), and visits were every 4 weeks; the clinical variable assessment, each physician's articular examination and DAS28 calculations were every 12 weeks and at baseline.

    Figure 1

    Subject disposition and study flow chart (A), tapering methods of biological agents (BA) (B) and percentage of subjects who met triple criteria for comprehensive disease remission over time (C–F) (non-responder imputation). (A) Investigators may have listed more than one reason. (B) …

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    Footnotes

    • Contributors Study conception and design: YU and K-iF. Acquisition of data: YU and YN. Analysis and interpretation of data: YU and K-iF.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the institutional review committee at each participating centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.