RESEARCH - Intensive treatment with MTX in early RA: aiming for remission - CAMERA

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Ann Rheum Dis. 2007 Nov;66(11):1443-9. Epub 2007 May 22.

Comment in:

Ann Rheum Dis. 2007 Nov;66(11):1409-10.

Nat Clin Pract Rheumatol. 2008 Jul;4(7):338-9.

Intensive treatment with methotrexate in early rheumatoid arthritis:

aiming for remission. Computer Assisted Management in Early Rheumatoid

Arthritis (CAMERA, an open-label strategy trial).

Verstappen SM, s JW, van der Veen MJ, Heurkens AH, Schenk Y, ter

Borg EJ, Blaauw AA, Bijlsma JW; Utrecht Rheumatoid Arthritis Cohort

study group.

University Medical Center Utrecht, Utrecht, the Netherlands.

BACKGROUND: To investigate whether intensive treatment with

methotrexate (MTX) according to a strict protocol and a computerised

decision program is more beneficial compared to conventional treatment

with MTX in early rheumatoid arthritis.

METHODS: In a two-year multicentre open label strategy trial, 299

patients with early rheumatoid arthritis were randomly assigned to the

intensive strategy group or the conventional strategy group. Patients

in both groups received MTX, the aim of treatment being remission.

Patients in the intensive treatment group came to the outpatient

clinic once every month; adjustment of the MTX dosage was tailored to

the individual patient on the basis of predefined response criteria,

using a computerised decision program. Patients of the conventional

strategy group came to the outpatient clinic once every three months;

they were treated according to common practice. Cyclosporine was added

if patients had an inadequate response to maximal tolerated MTX doses.

RESULTS: Seventy six (50%) patients in the intensive strategy group

achieved at least one period of remission during the two year trial,

versus 55 patients (37%) in the conventional strategy group (p =

0.03). Areas under the curve for nearly all clinical variables were

significantly lower-that is, there was a better clinical effect for

the intensive treatment group compared with the conventional treatment

group.

CONCLUSION: The results of this study show that it is possible to

substantially enhance the clinical efficacy early in the course of the

disease by intensifying treatment with MTX, aiming for remission,

tailored to the individual patient. Furthermore, participating

rheumatologists indicated that the computerised decision program could

be a helpful tool in their daily clinical practice.

PMID: 17519278

http://www.ncbi.nlm.nih.gov/pubmed/17519278

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