Treating to target matrix metalloproteinase 3 normalisation together with disease activity score below 2.6 yields better effects than each alone in rheumatoid arthritis patients: T-4 Study.

Abstract

OBJECTIVES:

To assess whether therapy to achieve both a disease activity score in 28 joints (DAS28) less than 2.6 and matrix metalloproteinase (MMP) 3 normalisation offers better outcomes than either target alone in early rheumatoid arthritis (RA) at 56 weeks: Treating to Twin Targets (T-4) Study.

METHODS:

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). Medication was started with sulfasalazine (1 g/day) in all intervention groups. Targets were DAS28 less than 2.6 for the D group, MMP-3 normalisation for the M group and both DAS28 less than 2.6 and MMP-3 normalisation for the T group. If the value in question did not fall below the previously measured level, medication was intensified, including methotrexate, other disease-modifying antirheumatic drugs and biological agents. Primary, secondary and outcome measures consisted of the proportions of patients showing clinical remission (DAS28 <2.6), radiographic non-progression (Δmodified total Sharp score ≤0.5), normal physical function (modified health assessment questionnaire score 0), or comprehensive disease remission defined as the combination of clinical remission, radiographic non-progression and normal physical function.

RESULTS:

Clinical remission at 56 weeks was achieved by more patients in the T group (56%) than in the R group (p<0.0005) or M group (p<0.0005).

CONCLUSIONS:

Results of the T-4 Study reveal that a twin target strategy can achieve a high clinical remission rate in early RA.

• Authors: Yukitomo Urata, Ryoko Uesato, Dai Tanaka, Yoshihide Nakamura, Shigeru Motomura
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 71 Issue 4 Pg. 534-40 (Apr 2012) ISSN: 1468-2060 [Electronic] England
• PMID: 22021897 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Antirheumatic Agents
• Biological Products
• Biomarkers
• Immunosuppressive Agents
• Sulfasalazine
• Matrix Metalloproteinase 3
• Methotrexate

Topics

• Adult
• Aged
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, enzymology)
• Biological Products (therapeutic use)
• Biomarkers (blood)
• Drug Monitoring (methods)
• Drug Therapy, Combination
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Matrix Metalloproteinase 3 (blood)
• Methotrexate (therapeutic use)
• Middle Aged
• Severity of Illness Index
• Sulfasalazine (therapeutic use)
• Treatment Outcome
• Young Adult