Emery P,Horton1 S, Dumitru RB, et al. - This study was intended to validate in very early rheumatoid arthritis (ERA) a much greater superiority (30%) of the first-line etanercept+methotrexate (ETN+MTX) over treat-to-target MTX (MTX-TT) than previously reported in ERA (14%), and investigate whether ETN following initial MTX secures a comparable response to first-line ETN+MTX. A total of 120 individuals were included, 60 to each arm (71% female, 73% RF/84% ACPA positive, median (IQR) symptom duration 20.3 (13.1, 30.8) weeks; mean (SD) DAS28 5.1 (1.1)). Individuals were assigned randomly in 1:1 ratio to ETN+MTX; or MTX-TT escalated to ETN if week 24 DAS28-ESR ≥ 2.6 and intramuscular corticosteroid at protocolized time points. Researchers did not show a larger effect in very ERA compared with remission rates typically reported with first-line tumour necrosis factor inhabitor+MTX vs MTX-TT. Although ultrasound confirmed local inflammation suppression, neither strategy conferred remission in the majority of individuals. Also, poorer ETN response following the failure of MTX-TT is implied.