Key clinical point: Significant proportion of patients with high-risk early rheumatoid arthritis (RA) achieved the treatment target with a combination of methotrexate and step-down prednisolone, whereas nonresponders benefited from treatment intensification albeit with more adverse events.
Major finding: Overall, 73% of patients at high risk achieved the treatment target at 13 weeks. A significant proportion of nonresponders who were at high risk achieved the treatment target with treatment intensification vs continuation (80% vs 44%; difference 36%; P = .04), but experienced more adverse events (P < .01).
Study details: This study included 190 patients with early RA from the COBRA treat-to-target trial, of which high-risk patients received prednisolone (30 mg/day tapered to 7.5 mg/day) and methotrexate (increased from 10 to 25 mg/week). At 13 weeks, nonresponders were randomly assigned to treatment continuation or intensification (methotrexate 25 mg/week; prednisolone 60 mg/day tapered to 7.5 mg/day; sulfasalazine 2 g/day; and hydroxychloroquine 400 mg/day).
Disclosures: This study was supported by an unrestricted grant from Pfizer. M Boers and WF Lems reported ties with various sources.
Source: Hartman L et al. Favorable effect of a ‘second hit’ after 13 weeks in early RA non-responders: The Amsterdam COBRA treat-to-target randomized trial. Rheumatology (Oxford). 2022 (Oct 7). Doi: 10.1093/rheumatology/keac582