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Pragmatic randomised controlled trial of very early etanercept and mtx versus mtx with delayed etanercept in ra: the vedera trial

Annals of Rheumatic Diseases Mar 23, 2020

Emery P, Horton S, Dumitru RB, et al. - Researchers intended to validate in very early rheumatoid arthritis (ERA) a much greater superiority (30%) of first-line etanercept+methotrexate (ETN+MTX) over treat-to-target MTX (MTX-TT) than previously reported in ERA (14%); and explore whether ETN following initial MTX secures a comparable response to first-line ETN+MTX. In this study, 120 patients were assigned randomly, 60 to each arm (71% female, 73% RF/84% ACPA positive, median 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 whether week 24 DAS28-ESR ≥ 2.6 and intramuscular corticosteroid at protocolised time points. This study did not indicate a larger impact 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. In addition, poorer ETN response following failure of MTX-TT is also recommended.

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