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Long-term outcome is better when a methotrexate-based treatment strategy is combined with 10 mg prednisone daily: follow-up after the second Computer-Assisted Management in Early Rheumatoid Arthritis trial
  1. M Safy,
  2. JWG Jacobs,
  3. ND IJff,
  4. JWJ Bijlsma,
  5. JM van Laar,
  6. MJH de Hair
  7. On behalf of the Society for Rheumatology Research Utrecht (SRU)
  1. Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to M Safy, Department of Rheumatology & Clinical Immunology, F.02.127, University Medical Center Utrecht, Box 85500, Utrecht 3508, GA, The Netherlands; m.safy{at}


Objectives In the second Computer-Assisted Management in Early Rheumatoid Arthritis trial, patients had started with methotrexate and 10 mg prednisone (MTX+pred) or placebo (MTX+plac). After the trial, prednisone was tapered and stopped, if possible. The objective was to compare, during the post-trial follow-up between the two former strategy groups, initiation of the first biological disease-modifying antirheumatic drug (bDMARD), radiographic outcome and onset of glucocorticoid (GC)-related comorbidities.

Methods Data on prednisone and bDMARD use and onset of GC-related comorbidities were collected retrospectively. Sharp/van der Heijde scoring was performed. Data were analysed using Fisher’s exact and Mann-Whitney U tests.

Results Of 218 patients post-trial follow-up data were available. The maximum follow-up time was 11.8 years. Fewer patients initiated a first bDMARD in the former MTX+pred compared with the former MTX+plac strategy group: 31% vs 50%, p=0.003. At the 2 year post-trial follow-up, the median erosion score was significantly lower in the former MTX+pred versus former MTX+plac strategy group: 0 (range 0–0) versus 0 (0–2), p=0.002. No significant differences between the former strategy groups in the onset of GC-related comorbidities during the post-trial follow-up were found.

Conclusion Addition of 10 mg prednisone daily to an MTX-based treatment strategy in early rheumatoid arthritis results in a lower initiation rate of a first bDMARD and significantly better radiographic outcomes, yet does not result in more GC-related comorbidities.

  • rheumatoid arthritis
  • glucocorticoids
  • biologicals
  • outcome

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  • Contributors All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafted the work or revised it critically for important intellectual content and made a final approval of the version to be published.

  • Competing interests JMvL received honoraria from MSD, Roche, Pfizer, BMS, Eli Lilly. JWJB received honoraria from AbbVie, BMS, MSD, Pfizer, Roche, SUN, UCB. MS was supported by a research grant from Astra Zeneca. Astra Zeneca was not involved in this study.

  • Ethics approval The institutional review boards of the participating centres confirmed that the Medical Research Involving Human Subjects Act (WMO) was not applicable to this study.

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

  • Collaborators Contributing SRU hospitals and contact persons: University Medical Center Utrecht, Dr J. Tekstra; Antonius Hospital Nieuwegein/Utrecht, Dr E.J. ter Borg; Diakonessen Hospital Utrecht, Drs Y. Schenk; Meander Medical Center Amersfoort, Dr S. Linn-Rasker; Sint Jansdal Hospital Harderwijk, Drs J. Peeters; Tergooi Hospital Hilversum, Dr Z.N. Jahangier; Flevo Hospital Almere, Dr C.M. Verhoef.

  • Correction notice This article has been corrected since it published Online First. The legend for fig 1 has been added and the author names for M Safy and MJH De Hair corrected.