Table 1 Targets and visit intervals (left columns) and clinical, functional and structural outcomes (right columns) of core trials Group (A) TICORA26 Targeted group (T) Routine control group (R) Treatment-decision driving target DAS<2.4 LDA Opinion of treating rheumatologist Interval of controls 1 Month 1 Month (B) CAMERA27 Targeted group (T) Routine control group (R) (C) Fransen et al28 Targeted group (T) Routine control group (R) (D) Symmons et al29 Targeted group (T) Routine control group (R) Improvement of number of swollen joints: >20% compared to previous visit/50% compared to baseline Improvement in 2 out of 3 criteria: ESR, TJC, PGA >20% compared to previous visit Decrease of SJC, if number of SJ unchanged, assessors’ judgement, looking at TJC, ESR, PGA DAS28<3.2 LDA Opinion of treating rheumatologist CRP<twice the upper limit of normal range TJC=0 and SJC=0 Symptom control Symptom control (E) Edmonds et al31 (abstract) Targeted group I CRP normal range Targeted group II SJC <3 Routine control group (F) van Tuyl et al30 Targeted group I Targeted group II (G) Stenger et al32 Targeted group (T) Routine control group (R) – DAS28<3.2 LDA Cartilage degradation: CTX-II excretion ≤150 nmol/mmol creatinine CRP decrease >50% Opinion of treating rheumatologist N 55 55 233 233 82 85 82 11 10 139 89 1 Month 151 3 Months 148 At least every 4 months (both groups) 1 Month (both groups) 8 Weeks, then 13 weeks (both groups) 8 Weeks (both groups) Extended report Outcomes/ﬁnal treatment target p Values indicate differences of outcomes between the targeted (T) and the routine group (R) Clinical outcome at 18 months EULAR good response (primary outcome): OR* 5.8 (2.4 to 13.9); 82% targeted (T) versus 44% routine (R); p<0.0001 EULAR remission: OR* 9.7 (3.9 to 23.9), 64% T versus 16% R; p<0.0001 ACR70: OR* 11 (4.5 to 27), 71% T versus 18% R; p<0.0001 Functional outcome at 18 months HAQ change: −0.97±0.8 T versus −0.47±0.9 R; p=0.0025 Radiographic outcome at 18 months; median (IQR) Progression of erosion score: 0.5 (0–3.357) T versus 3 (0.5–8.5) R; p=0.002 Change in TSS: 4.5 (1–9.875) T versus 8.5 (2.0–15.5) R; p=0.02 Change in JSN: 3.25 (1.125–7.5) T versus 4.5 (1.5–9.0) R; p=0.331 Clinical outcome at 1 year† and at 2 years‡ Number of patients in remission for 3 months (primary outcome): 35% T versus 14% R; p<0.001† 50% T versus 37% R; p<0.029‡ Mean (95% CI) time until remission (months): 10.4 (9.1 to 11.7) T versus 14.3 (12.6 to 16.1) R; p<0.001 Duration (months) of all periods of remission: 11.6 (10.1–13.1) T versus 9.1 (7.6–10.6) R; p=0.025 ACR50: 58% T versus 43% R; p<0.01† 46% T versus 45% R; p=NS‡ Functional outcome at 1 year† and at 2 years‡ HAQ mean±SD-change: −0.44±0.59 T versus −0.39±0.66 R; p=NS†; −0.41±0.64 T versus −0.42±0.76 R; p=NS‡ Radiographic outcome at 2 years Annual radiographic progression: median (IQR) change (units/year): 0 (0–2.0) T versus 0 (0–2.5) R; p=0.9 Clinical outcome at 3 years: (adjusted mean difference (95% CI)) EGA: 3.76 (0.03–7.52); p=0.045 OSRA: 0.41 (0.01–0.71); p=0.010 SJC, TJC, ESR and PGA: p=NS Functional outcome at 3 years: HAQ (primary outcome): sign deterioration in both arms; mean difference between T and R: p=0.82 Radiographic outcome at 3 years: Total Larsen score: deterioration in both arms of (signiﬁcant in routine group (p=0.035) but not in the targeted group (p=0.093); difference T versus R: p=NS Eroded joint count: increased slightly in both treatment arms, difference T versus R: p=NS Clinical outcome at 2 years: Target ‘SJC<3’ was met in 29%, target ‘normal CRP’ in 41% of visits (p: NA) Functional outcomes: NR Radiographic outcomes at 2 years Radiographic progression scores NS between study arms but: erosion progression 0.2±1.0 versus 1.0±2.5 (p<0.03), JSN 0.3±1.3 versus 1.2±2.6 (p<0.03), total score 0.5±1.6 versus 2.2±4.2 (p<0.005) if AUC-CRP target achieved, as compared to not achieved (not the case for SJC-target) (p NA). Clinical outcomes at 40 weeks Remission rates: in both targeted arms: 90% (after 8 and 21 weeks: 57% and 76%) ACR20/50/70/90: 100%/95%/71%/43% Functional outcomes: NR Radiographic outcomes: NR Clinical outcomes at 1 year† and at 2 years‡ AUC-CRP (mg (week/l; median (range)): 1136 (144–3563) T versus 1836 (26–8051) R; p=0.02†; 1963 (212–8515) T versus 3025 (46–15632) R; p=0.002‡ Functional outcomes: NR Radiographic outcomes at 1 year† and at 2 years‡ Median (range) progression rate: 17.0 (0–74) T versus 17.5 (0–130) R; p=0.22† 26.0 (0–100) T versus 35 (1–188) R; p=0.03‡ 1 Month starting, 205 then 2 months, 179 then 3 months (both groups) Clinical outcome at 24 weeks Patients in DAS28/LDA: 31% T versus 16% R; p=0.028 Mean±SD changes in DAS28: −0.4±1.0 T versus −0.14±1.2 R; p=0.36 DMARD changes: 20% T versus 9% R; p=0.013 Functional data: NR (NS) Radiographic: NR *OR (95% CI); †outcome at 1 year; ‡outcome at 2 years. AUC, area under the curve; ACR, American College of Rheumatology; CAMERA, Computer Assisted Management in Early Rheumatoid Arthritis; CRP, C reactive protein; CTX-II, C-terminal cross-linking of type II collagen; DAS, Disease Activity Score; DMARD, disease-modifying antirheumatic drugs; EGA, evaluator global assessment; ESR, erythrocyte sedimentation rate; EULAR, European League Against Rheumatism; HAQ, Health Assessment Questionnaire; JSN, joint space narrowing; LDA, low disease activity; NR, not reported; OSRA, overall status in rheumatoid arthritis; PGA, physician’s global assessment; SJC, swollen joint count; TICORA, tight control of rheumatoid arthritis; TJC, total joint count; TSS, total Sharp score. Ann Rheum Dis 2010;69:638–643. doi:10.1136/ard.2009.123976 03_ar123976.indd 641 641 3/10/2010 11:52:43 AM