title: Feasibility of tailored treatment based on risk stratification in patients with early rheumatoid arthritis.
abstract: BACKGROUND
  Personalized medicine is the holy grail of medicine. The EULAR recommendations for the management of rheumatoid arthritis (RA) support differential treatment between patients with baseline characteristics suggestive of a non-poor prognosis (non-PP) or poor prognosis (PP) (presence of autoantibodies, a high inflammatory activity and damage on radiographs). We aimed to determine which prognostic risk groups benefit more from initial monotherapy or initial combination therapy.
  
  
  METHODS
  508 patients were randomized to initial monotherapy (iMono) or initial combination therapy (iCombo). Disease outcomes of iMono and iCombo were compared within non-PP or PP groups as determined on baseline characteristics
  
  
  RESULTS
  PP patients treated with iCombo after three months more often achieved ACR20 (70% vs 38%, P <0.001), ACR50 (48% vs 13%, P <0.001) and ACR70 response (24% vs 4%, P <0.001) than those treated with iMono, and had more improvement in HAQ (median decrease 0.75 vs 0.38, P <0.001). After 1 year, differences in ACR20 response and DAS-remission remained; PP patients treated with iCombo (vs iMono) had less radiographic progression (median 0.0 vs 1.5, P =0.001).
  
  
  CONCLUSIONS
  Since PP and non-PP patients benefit equally from iCombo through earlier clinical response and functional improvement than with iMono, we conclude that personalized medicine as suggested in the guidelines is not yet feasible. The choice of treatment strategy should depend more on rapid relief of symptoms than on prognostic factors.
  
  
  BACKGROUND
  Netherlands Trial Register NTR262 (registered 7 September 2005) and NTR265 (8 September 2005).
authors.forename: Iris M
authors.initials: IM
authors.lastname: Markusse
authors.forename: Jeska K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
authors.forename: K Huub
authors.initials: KH
authors.lastname: Han
authors.forename: Peter A H M
authors.initials: PA
authors.lastname: van der Lubbe
authors.forename: Anne A
authors.initials: AA
authors.lastname: Schouffoer
authors.forename: Pit J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D016572:Cyclosporine / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D012460:Sulfasalazine / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D012460:Sulfasalazine; D016572:Cyclosporine; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate