PT  - JOURNAL ARTICLE
AU  - Yukitomo Urata
AU  - Ryoko Uesato
AU  - Dai Tanaka
AU  - Yoshihide Nakamura
AU  - Shigeru Motomura
TI  - Treating to target matrix metalloproteinase 3 normalisation together with disease activity score below 2.6 yields better effects than each alone in rheumatoid arthritis patients: T-4 Study
AID  - 10.1136/annrheumdis-2011-200108
DP  - 2012 Apr 01
TA  - Annals of the Rheumatic Diseases
PG  - 534--540
VI  - 71
IP  - 4
4099  - http://ard.bmj.com/content/71/4/534.short
4100  - http://ard.bmj.com/content/71/4/534.full
SO  - Ann Rheum Dis2012 Apr 01; 71
AB  - Objectives To assess whether therapy to achieve both a disease activity score in 28 joints (DAS28) less than 2.6 and matrix metalloproteinase (MMP) 3 normalisation offers better outcomes than either target alone in early rheumatoid arthritis (RA) at 56 weeks: Treating to Twin Targets (T-4) Study. Methods 243 early RA patients were randomly allocated to one of four strategy groups: routine care (R group; n=62); DAS28-driven therapy (D group; n=60); MMP-3-driven therapy (M group; n=60); or both DAS28 and MMP-3-driven therapy group (twin; T group; n=61). Medication was started with sulfasalazine (1 g/day) in all intervention groups. Targets were DAS28 less than 2.6 for the D group, MMP-3 normalisation for the M group and both DAS28 less than 2.6 and MMP-3 normalisation for the T group. If the value in question did not fall below the previously measured level, medication was intensified, including methotrexate, other disease-modifying antirheumatic drugs and biological agents. Primary, secondary and outcome measures consisted of the proportions of patients showing clinical remission (DAS28 <2.6), radiographic non-progression (Δmodified total Sharp score ≤0.5), normal physical function (modified health assessment questionnaire score 0), or comprehensive disease remission defined as the combination of clinical remission, radiographic non-progression and normal physical function. Results Clinical remission at 56 weeks was achieved by more patients in the T group (56%) than in the R group (p<0.0005) or M group (p<0.0005). Conclusions Results of the T-4 Study reveal that a twin target strategy can achieve a high clinical remission rate in early RA.