Treatment strategies in recent-onset rheumatoid arthritis : the best study

Abstract

This thesis describes the outcomes of 2 year follow-up of the BeSt study (Behandel-Strategieen). This is a multicenter, randomized clinical trial comparing 4 different treatment strategies in patients with recent-onset active rheumatoid arthritis: 1. sequential monotherapy, starting with methotrexate, switching to another antirheumatic drug in case of an insufficient response; 2. step-up combination therapy, also starting with methotrexate, adding other antirheumatic drugs in case of an insufficient response; 3. initial combination therapy with methotrexate, sulphasalazine and high-dose tapered prednisone; 4. initial combination therapy with methotrexate and infliximab. In all groups the goal was to achieve a disease activity score (DAS) __2.4 (low disease activity). The DAS was measured 3-monthly by a research nurse, blinded for the allocated group. The physician then adjusted therapy according to the protocol. During the 2 year follow-up, groups 3 and 4 had a more rapid clinical response, less joint damage and less treatment adjustments than groups 1 and 2. Interestingly, groups 1 and 2 did better than expected. This is probably the result of aimimg for low disease activity. Most patients prefer treatment with the newest drug. The higher costs of infliximab can largely be compensated by savings on productivity.UBL - phd migration 201