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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EFinal results of the Induction Therapy with Methotrexate and Prednisone in Rheumatoid or Very Early Arthritis Disease [IMPROVED] study showed that patients with rheumatoid arthritis and undifferentiated arthritis achieved similarly greater rates of remission after early initial treatment with combination therapy (methotrexate and prednisone). Patients who failed to achieve early remission benefited more when switched to a treatment strategy with adalimumab than with multiple disease modifying antirheumatic drugs, with virtually no radiographic damage progression in all patients.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatoid Arthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFinal results of the Induction Therapy with Methotrexate and Prednisone in Rheumatoid or Very Early Arthritis Disease [IMPROVED] study, reported by Lotte Heimans, MD, Leiden University Medical Center, Leiden, The Netherlands, showed that patients with rheumatoid arthritis (RA) and undifferentiated arthritis (UA) achieved similarly greater rates of remission after early initial treatment with combination therapy (methotrexate [MTX] and prednisone). Patients who failed to achieve early remission benefited more when switched to a treatment strategy with adalimumab than with multiple disease modifying antirheumatic drugs (DMARDs), with virtually no radiographic damage progression in all patients.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe objectives of the IMPROVED trial were to assess if induction of remission and drug-free remission is possible with initial combination therapy in early RA and UA, to determine which strategy results in more remission if the initial combination fails, and to compare results in RA and UA patients. The study included adult patients with RA (2010 criteria; n=479) of \u0026lt;2 years duration or rheumatologist-determined UA (n=122). The goal was remission (Disease Activity Score [DAS] \u0026lt;1.6).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAll patients were initially treated with MTX (25 mg QW) and prednisone (60 mg QD tapered to 7.5 mg QD over 7 weeks). Prednisone was tapered then discontinued for patients with a DAS \u0026lt;1.6 at 4 months. MTX was tapered for patients with a DAS \u0026lt;1.6 at 8 months. If remission was lost after 8 months, prednisone was restarted at 7.5 mg QD. Patients not in remission at 4 months were randomized to Arm 1 (MTX + prednisone + sulfhasalazine 2000 mg QD + hydroxychloroquine 400 mg QD [poly DMARDs + prednisone]; n=83) or Arm 2 (MTX + adalimumab [ADA] 40 mg every 2 weeks; n=78). Patients in either arm achieving remission at 8 months had their treatments tapered to MTX monotherapy. If not in remission after 8 months, patients in Arm 1 switched to ADA plus MTX and patients in Arm 2 increased ADA to 40 mg QW.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt baseline, RA patients had significantly (p\u22640.02) higher DAS and Health Assessment Questionnaire scores compared with UA patients; 68% of RA patients were positive for anticitrullinated protein antibody plus (ACPA+) compared with 3% of UA patients (p\u0026lt;0.001). Mean age was 52 years; 70% of RA and 61% of UA patients were women; mean symptom duration was \u223c17 weeks. Proportions of remission and radiographic progression measured by Sharp\/van der Heijde score (SHS) after 1-year follow-up were compared between the different treatment strategies.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EEarly remission (4 months) was achieved by 61% of all patients (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). At 1 year, 68% of those 61% were in remission and 32% were in drug-free remission. Significantly more patients in arm 2 (MTX + ADA, 41%) achieved remission at 1 year compared with those in arm 1 (poly DMARDs + prednisone, 25%; p=0.01). There was no difference between RA (62%) and UA (65%) patients who achieved early remission (p=0.46) or 1 year remission (53% vs 58%, respectively; p=0.1). Damage progression was minimal. Only 33 patients showed a 1-point progression on SHS. Toxicity was comparable between the 2 randomized arms.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/19\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022IMPROVED Study Design.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-834713664\u0022 data-figure-caption=\u0022IMPROVED Study Design.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/19\/17\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/19\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/19\/17\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11706\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EIMPROVED Study Design.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDAS=Disease Activity Score; HCQ=hydroxychloroquine; MTX=methotrexate; SSZ=sulfasalazine.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from L Heimans, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EIn this treat-to-remission cohort, early remission more often led to remission at 1 year (radiological damage progression after 1 year and drug-free remission). Also, remission-steered therapies led to minimal radiographic damage in UA and RA patients regardless of the treatment employed.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/19\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn5hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn5hd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}