title: Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment: A Randomized Trial.
abstract: BACKGROUND
  Treat-to-target therapy is effective for patients with rheumatoid arthritis (RA), but long-term results of continued targeted treatment are lacking.
  
  
  OBJECTIVE
  To evaluate long-term outcomes in patients with early RA after 10 years of targeted treatment in 4 treatment strategies.
  
  
  METHODS
  Randomized trial. (Nederlands Trial Register: NTR262 and NTR265).
  
  
  METHODS
  The Netherlands.
  
  
  METHODS
  508 patients with early active RA.
  
  
  METHODS
  Sequential monotherapy (strategy 1), step-up combination therapy (strategy 2), or initial combination therapy with prednisone (strategy 3) or with infliximab (strategy 4), all followed by targeted treatment aiming at low disease activity.
  
  
  METHODS
  Functional ability (Health Assessment Questionnaire [HAQ] score) and radiographic progression (Sharp-van der Heijde score) were primary end points. Survival in the study population was compared with the general population using the standardized mortality ratio.
  
  
  RESULTS
  195 of 508 of patients (38%) dropped out of the study (28% in strategy 4 vs. 40% to 45% in strategies 1 to 3, respectively). At year 10, mean HAQ score (SD) was 0.57 (0.56); 53% and 14% of patients were in remission and drug-free remission, respectively, without differences among the strategies. Over 10 years, mean HAQ scores were 0.69, 0.72, 0.64, and 0.58 in strategies 1 to 4, respectively (differences not clinically relevant). Radiographic damage was limited for all strategies, with mean Sharp-van der Heijde estimates during follow-up of 11, 8, 8, and 6 in strategies 1 to 4, respectively (P = 0.15). Standardized mortality ratio was 1.16 (95% CI, 0.92 to 1.46) based on 72 observed and 62 expected deaths, with similar survival among the 4 strategies (P = 0.81).
  
  
  CONCLUSIONS
  Dropout rate varied by strategy.
  
  
  CONCLUSIONS
  In patients with early RA, initial (temporary) combination therapy results in faster clinical improvement and targeted treatment determines long-term outcomes. Drug-free remission, with prevention of functional deterioration and clinically relevant radiographic damage, and normalized survival are realistic outcomes.
  
  
  BACKGROUND
  Dutch College of Health Insurance Companies, Schering-Plough, and Janssen.
authors.forename: Iris M
authors.initials: IM
authors.lastname: Markusse
authors.forename: Gülsah
authors.initials: G
authors.lastname: Akdemir
authors.forename: Linda
authors.initials: L
authors.lastname: Dirven
authors.forename: Yvonne P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.forename: Johannes H L M
authors.initials: JH
authors.lastname: van Groenendael
authors.forename: K Huub
authors.initials: KH
authors.lastname: Han
authors.forename: T H Esmeralda
authors.initials: TH
authors.lastname: Molenaar
authors.forename: Saskia
authors.initials: S
authors.lastname: Le Cessie
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Peter A H M
authors.initials: PA
authors.lastname: van der Lubbe
authors.forename: Pit J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: André J
authors.initials: AJ
authors.lastname: Peeters
authors.forename: H Karel
authors.initials: HK
authors.lastname: Ronday
authors.forename: Peter B J
authors.initials: PB
authors.lastname: de Sonnaville
authors.forename: Irene
authors.initials: I
authors.lastname: Speyer
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Saskia
authors.initials: S
authors.lastname: Ten Wolde
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab; D011241:Prednisone