A recent study evaluated the treat-to-target strategy by assessing whether patients with early rheumatoid arthritis (RA) who start methotrexate as monotherapy had similar or worse outcomes compared with patients who started with adalimumab plus methotrexate.
Guidelines from the European League Against Rheumatism and the American College of Rheumatology recommend clinical remission (or low disease activity [LDA] if clinical remission is unlikely) as the treatment goal for a patient with rheumatoid arthritis (RA). While conventional disease-modifying antirheumatic drugs (DMARDs), including methotrexate, are recommended as part of an initial treatment strategy, if disease activity has not improved at 3 months, or a clinical target is not reached at 6 months, the addition of a biologic therapy, such as an anti—tumor necrosis factor (anti-TNF) is recommended.
A recent study published in Annals of the Rheumatic Diseases evaluated the treat-to-target strategy by assessing whether patients with early RA who start methotrexate as monotherapy, (followed by the anti-TNF agent adalimumab if they failed to achieve treatment goals with methotrexate alone), had similar or worse outcomes compared to patients who started with adalimumab plus methotrexate.
The 78-week, randomized, double-blind, phase 4 study included methotrexate-naïve patients who had active RA for more than 1 year. In the first study period, patients received methotrexate as monotherapy weekly (n = 460) or adalimumab at 40 mg every other week plus methotrexate weekly for 26 weeks (n = 466). In the second period, patients with stable LDA continued methotrexate as monotherapy or were re-randomized to adalimumab plus methotrexate for continuation or adalimumab withdrawal.
The researchers found the following:
The researchers concluded that starting treatment with methotrexate as monotherapy and adding adalimumab if a patient fails to respond adequately at 26 weeks allowed patients with early RA to achieve comparable long-term clinical, functional, and disease-activity outcomes as those who began initial adalimumab plus methotrexate combination therapy, and that this strategy helped to prevent overtreatment of patients with early RA.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
Early Involvement Critical in Treating Immunotherapy-Induced Overlap Syndrome
April 19th 2024A series of case studies reveals the importance of early diagnosis and involvement of special teams of clinicians when dealing with potential cases of overlap syndrome, which encompasses myocarditis, myasthenia gravis, and immune checkpoint inhibitor–related myositis.
Read More
Making Giant Strides in Maternity Health Through Baby Steps
April 9th 2024To help celebrate and recognize National Minority Health Month, we are kicking off a special month-long podcast series with our strategic alliance partner, UPMC Health Plan. Welcome to our first episode, which is all about the Baby Steps Maternity Program and its mission to support women throughout every step of their pregnancy journey.
Listen