Testing treat-to-target outcomes with initial Methotrexate monotherapy compared with initial tumour necrosis factor inhibitor (adalimumab) plus Methotrexate in early rheumatoid arthritis

Disease-modifying antirheumatic drugs (DMARDs), especially methotrexate (MTX) are the most recommended treatment for Rheumatoid Arthritis (RA). If the patient activity is not improved after three months of treatment, the addition of a biological DMARD (bDMARD), such as a tumor necrosis factor inhibitor (TNFi), is recommended. Therefore, in the present research, the authors revealed that the combination of adalimumab and MTX prevented potential overtreatment of approximately 25% of patients with early RA.

The study involved the comparisons of responses among the early rheumatoid arthritis (RA) patients initially operated with MTX monotherapy versus adalimumab+methotrexate (MTX) who may have sustained taking MTX or shifted to adalimumab rescue therapy following poor response to MTX.

MTX-naive patients with progressive RA for <1 year was selected by OPTIMA which analyzed patients who were at their initial treatment stage and showed <3.2 28-joint modified Disease Activity Score with no radiographic improvement at weeks 26, 52 and 78.

The higher proportion of patients of initially treated adalimumab+ MTX showed considerably excellent functional, clinical and radiographic outcomes at week 26 as compared to MTX monotherapy. Further, patients under adalimumab-rescue obtained identical functional and clinical results than patients initially managed with adalimumab+MTX from 26 to 78 weeks. Although, considerably more patients initially dosed with adalimumab+MTX had no radiographic improvement at weeks 52 and 78 as compared to patients initially treated with MTX.

The patients with early RA who initiated  MTX monotherapy and including TNFi following 26 weeks showed similar longer-term clinical results as starting with TNFi+MTX combination treatment, however, allow a small but important accrual of radiographic damage.