PT  - JOURNAL ARTICLE
AU  - Arthur Kavanaugh
AU  - Ronald F van Vollenhoven
AU  - Roy Fleischmann
AU  - Paul Emery
AU  - Iain Sainsbury
AU  - Stefan Florentinus
AU  - Su Chen
AU  - Benoît Guérette
AU  - Hartmut Kupper
AU  - Josef S Smolen
TI  - Testing treat-to-target outcomes with initial methotrexate monotherapy compared with initial tumour necrosis factor inhibitor (adalimumab) plus methotrexate in early rheumatoid arthritis
AID  - 10.1136/annrheumdis-2017-211871
DP  - 2017 Dec 04
TA  - Annals of the Rheumatic Diseases
PG  - annrheumdis-2017-211871
4099  - http://ard.bmj.com/content/early/2017/12/04/annrheumdis-2017-211871.short
4100  - http://ard.bmj.com/content/early/2017/12/04/annrheumdis-2017-211871.full
AB  - Objectives To compare responses in patients with early rheumatoid arthritis (RA) initially treated with the tumour necrosis factor inhibitor (TNFi) adalimumab+methotrexate (MTX) versus MTX monotherapy who may have continued receiving MTX or switched to adalimumab rescue therapy after inadequate response to MTX.Methods OPTIMA enrolled MTX-naive patients with active RA for <1 year. This post hoc analysis determined the proportion of patients, stratified by initial treatment, who achieved 28-joint modified Disease Activity Score based on C reactive protein <3.2, normal function and/or no radiographic progression at weeks 26, 52 and 78.Results Significantly greater proportions of patients initially treated with adalimumab+MTX (n=466) compared with MTX monotherapy (n=460) achieved good clinical (53% vs 30%), functional (45% vs 33%) and radiographic (87% vs 72%) outcomes at week 26. From weeks 26 to 78, adalimumab rescue patients achieved similar clinical and functional outcomes versus patients initially treated with adalimumab+MTX. However, significantly more patients initially treated with adalimumab+MTX had no radiographic progression at weeks 52 and 78 versus patients initially treated with MTX (both timepoints: 86% vs 72%).Conclusions In early RA, starting with MTX monotherapy and adding TNFi after 26 weeks yields similar longer term clinical results as starting with TNFi+MTX combination therapy but allows a small but significant accrual of radiographic damage.