Emery P, Horton S, Dumitru RB, et al. - Experts intended to confirm 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 examine whether ETN following initial MTX secures a comparable response to first-line ETN+MTX. A total of 120 individuals were assigned randomly, 60 to each arm (71% female, 73% RF/84% anticitrullinated peptide antibody positive, median (IQR) symptom duration 20.3 (13.1, 30.8) weeks; mean (SD) DAS28 5.1 (1.1)). They did not confirm 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 gave remission in the majority of individuals. In this VEDERA trial, poorer etanercept response following failure of MTX-TT is also recommended.