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Effectiveness of TNF inhibitor treatment with various methotrexate doses in patients with rheumatoid arthritis: results from clinical practice
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  1. Sofie H M Manders1,
  2. Wietske Kievit2,
  3. Eddy Adang2,
  4. Tim J Jansen3,
  5. Jan N Stolk4,
  6. Henk Visser5,
  7. Annemarie M Schilder6,
  8. Harald E Vonkeman7,
  9. Mart A F J van de Laar7,
  10. Piet L C M van Riel1
  1. 1Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
  3. 3Department of Rheumatic diseases, Radboud University Medical Center, Nijmegen, The Netherlands
  4. 4Department of Rheumatology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
  5. 5Department of Rheumatology, Rijnstate, Arnhem, The Netherlands
  6. 6Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  7. 7Department of Rheumatology, Arthritis Centre Twente, University of Twente and Medisch Spectrum Twente, Enschede, The Netherlands
  1. Correspondence to Sofie H M Manders, Department of IQ Healthcare, Radboud University Medical Center, Postbus 9101, Geert Grooteplein Noord 21 (route 114), Nijmegen 6500 HB, The Netherlands; sofie.manders{at}radboudumc.nl

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Tumour necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis is more effective when combined with methotrexate (MTX).1–3 However, little is known about which MTX dose to use. With great interest, we read the article by Burmester et al4 on the efficacy and safety of ascending MTX doses with adalimumab. This randomised double-blind study showed comparable results for adalimumab with 10 and 20 mg MTX, in MTX naive patients. Because of the potential side effects, it is often preferred to use MTX doses as low as possible. Therefore, the following questions arise: what happens in daily practice with MTX plus adalimumab, where most patients are not MTX naive when starting TNFi, and are the results the same for etanercept and infliximab?

Data were collected within the Dutch RhEumatoid Arthritis …

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