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