1207 - Treating to Target Matrix Metalloproteinase 3 Normalisation Together with Disease Activity Score Below 2.6 Yields Better Effects Than Each Alone In Rheumatoid Arthritis Patients: Treating to Twin Targets; T-4 Study

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Yukitomo Urata1, Ryoko Uesato1, Dai Tanaka1, Yoshihide Nakamura2 and Shigeru Motomura2, 1Seihoku Chuo Hospital, Gosyogawara, Japan, 2Hirosaki University Graduate School of Medicine, Hirosaki, Japan
Presentation Number: 1207

Background/Purpose: To assess whether therapy to achieve both disease activity score in 28 joints (DAS28) <2.6 and matrix metalloproteinase (MMP)-3 normalisation offers better outcomes than either target alone in early rheumatoid arthritis at 56 weeks; Treating to twine targets; T-4 study.

Method: A total of 243 early RA patients were randomly allocated to one of four strategy groups: routine care (R group; n=62); DAS28-driven therapy (D group; n=60); MMP-3-driven therapy (M group; n=60); or both DAS28- and MMP-3-driven therapy group (Twin; T group; n=61). Specifically, medication was started with sulfasalazine (1 g/day) in all intervention groups. Targets were DAS28 <2.6 for D group, MMP-3 normalisation for M group, and both DAS28 <2.6 and MMP-3 normalisation for T group. If the value in question did not fall below the previously measured level, we intensified medication including methotrexate, other disease-modifying anti-rheumatic drugs and biologic agents. Primary, secondary, tertiary and quaternary outcome measures consisted of the proportions of patients in clinical remission (DAS28 <2.6), showing radiographic nonprogression (Dmodified total Sharp score ≤0.5), showing normal physical function (modified Health Assessment Questionnaire score=0), and comprehensive disease remission defined as the combination of clinical remission, radiographic nonprogression, and structural normal physical function.

Results: Comprehensive disease remission at 56 weeks was achieved by more patients in T group (34%) than in R group (p<0.001), D group (p<0.05), or M group (p<0.001).


Results of the T-4 study revealed that comprehensive disease remission is an achievable goal in early RA with more aggressive therapy.

Keywords: DMARDs, Health Assessment Questionnaire, remission, rheumatoid arthritis (RA) and tumor necrosis factor (TNF)

Disclosure: Y. Urata, None; R. Uesato, None; D. Tanaka, None; Y. Nakamura, None; S. Motomura, None.