OBJECTIVES: To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early @entity309 (eRA) added to a @entity1499 and intra-articular @entity17990 treat-to-target strategy (NCT00660647). METHODS: Disease-modifying antirheumatic drug (DMARD)-naive @entity1 with eRA started @entity1499 (20   mg/week) and intra-articular @entity2713 (20   mg/ml) for 2 years. In addition, they were randomised to receive placebo adalimumab (DMARD group, n=91) or adalimumab (40   mg/every other week) (DMARD+adalimumab group, n=89) during the first year. @entity3378 and @entity6383 were added if disease activity persisted after 3 months. During year 2, synthetic DMARDs continued. Adalimumab was (re)initiated if active disease reoccurred. Clinical response, remission, disability, quality of life and radiographic changes were assessed. RESULTS: One year after adalimumab withdrawal, treatment profiles and clinical responses did not differ between groups. In the DMARD/DMARD+adalimumab groups, the median 2-year @entity1499 dose was 20/20   mg/week (p=0.45), triple DMARD therapy had been initiated in 33/27 @entity1 (p=0.49), adalimumab was (re)initiated in 12/12 @entity1 and cumulative @entity2713 dose was 160/120   mg (p=0.15). The treatment target (disease activity score, 4 variables, @entity1851 (DAS28CRP)  <=3.2 or DAS28>3.2 without swollen joints) was achieved at all visits in >= 85% of @entity1 in year 2; remission rates were DAS28CRP<2.6:69%/66%; Clinical Disease Activity Index  <=2.8:55%/57%; Simplified Disease Activity Index <3.3:54%/49%; American College of Rheumatology/European League against @entity627 (28 joints):44%/45% (p=0.66-1.00). Radiographic progression (  total Sharp score/year) was similar 1.31/0.53 (p=0.12). Erosive progression (  @entity2681 score (ES)/year) was year 1:0.57/0.06 (p=0.02); year 2:0.38/0.05 (p=0.005). Proportion of @entity1 without erosive progression (  ES <=0) was year 1: 59%/76% (p=0.03); year 2:64%/79% (p=0.04). CONCLUSIONS: An aggressive @entity2713 and synthetic DMARD treat-to-target strategy in eRA provided excellent 2-year clinical and radiographic disease control independent of adalimumab induction therapy. ES progression was slightly less during and following adalimumab induction therapy. TRIAL REGISTRATION NUMBER: NCT00660647.

Clinical and radiographic outcome of a treat-to-target strategy using XXXX and intra-articular glucocorticoids with or without adalimumab induction: a 2-year investigator-initiated, double-blinded, randomised, controlled trial (OPERA).

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1851 :: ('1401', 'Gene') :: ['C-reactive protein'] @entity627 :: ('MESH:D012216', 'Disease') :: ['Rheumatism'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis'] @entity2681 :: ('MESH:D014077', 'Disease') :: ['erosion'] @entity6383 :: ('MESH:D006886', 'Chemical') :: ['hydroxychloroquine'] @entity3378 :: ('MESH:D012460', 'Chemical') :: ['Sulfasalazine'] @entity1499 :: ('MESH:D008727', 'Chemical') :: ['methotrexate'] @entity17990 :: ('MESH:C005900', 'Chemical') :: ['triamcinolone hexacetonide'] @entity2713 :: ('MESH:D014221', 'Chemical') :: ['triamcinolone']
@entity1499 :: (MESH:D008727,Chemical) :: ['methotrexate']
