Documents
-
- Download
- Title Page_Contents
-
open access
-
- Download
- Chapter 01
-
open access
-
- Download
- Chapter 02
-
open access
- Full text at publishers site
-
- Download
- Chapter 03
-
open access
- Full text at publishers site
-
- Download
- Chapter 04
-
open access
-
- Download
- Chapter 05
-
open access
-
- Download
- Chapter 06
-
open access
- Full text at publishers site
-
- Download
- Chapter 07
-
open access
- Full text at publishers site
-
- Download
- Chapter 08
-
open access
-
- Download
- Chapter 09
-
open access
- Full text at publishers site
-
- Download
- Chapter 10_summary
-
open access
-
- Download
- Summary_in Dutch
-
open access
-
- Download
- CV_Publications_Acknowledgements
-
open access
In Collections
This item can be found in the following collections:
Improving targeted treatment in early rheumatoid and undifferentiated arthritis
The Induction therapy with Methotrexate and Prednisone in Rheumatoid Or Very Early arthritic Disease (IMPROVED)-study is a multicentre two-step randomized single-blinded clinical trial in 610 early rheumatoid arthritis (RA) and undifferentiated arthritis (UA) patients. Intensive induction therapy (methotrexate (MTX) and a tapered high dose of prednisone) was started in the first 4 months. Treatment adjustments aimed at clinical remission (Disease Activity Score (DAS)<1.6): if DAS<1.6, medication was tapered and stopped, if DAS≥1.6, medication was intensified or restarted. Patients not in DAS-remission after 4 months were randomized to triple therapy (MTX, hydroxychloroquine and sulfasalazine) with prednisone (arm 1) or MTX+adalimumab (arm 2).
After 4 months 61% was in DAS-remission (early DAS-remission group). After 5 years, 48% were in DAS-remission and 22% in drug-free remission (DFR). Patients in early DAS-remission group had better functional ability and more often...
Show moreThe Induction therapy with Methotrexate and Prednisone in Rheumatoid Or Very Early arthritic Disease (IMPROVED)-study is a multicentre two-step randomized single-blinded clinical trial in 610 early rheumatoid arthritis (RA) and undifferentiated arthritis (UA) patients. Intensive induction therapy (methotrexate (MTX) and a tapered high dose of prednisone) was started in the first 4 months. Treatment adjustments aimed at clinical remission (Disease Activity Score (DAS)<1.6): if DAS<1.6, medication was tapered and stopped, if DAS≥1.6, medication was intensified or restarted. Patients not in DAS-remission after 4 months were randomized to triple therapy (MTX, hydroxychloroquine and sulfasalazine) with prednisone (arm 1) or MTX+adalimumab (arm 2).
After 4 months 61% was in DAS-remission (early DAS-remission group). After 5 years, 48% were in DAS-remission and 22% in drug-free remission (DFR). Patients in early DAS-remission group had better functional ability and more often achieved DAS-remission and DFR than patients that were randomized, without differences between the arms. UA patients had lower DAS and less autoantibody positivity at baseline compared to the RA patients. DAS-remission percentages were comparable between RA and UA patients, but more UA patients did achieve DFR (33% vs 19%). Autoantibody (rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA)) negative patients more often achieved DFR.
Show less- All authors
- Akdemir, G.
- Supervisor
- Huizinga, T.W.J.
- Co-supervisor
- Allaart, C.F.
- Committee
- Heijde, D.M.F.M.; Lems, W.F.; Reijnierse, M.; Peeters, A.J.
- Qualification
- Doctor (dr.)
- Awarding Institution
- Reumatologie , Medicine / Leiden University Medical Center (LUMC) , Leiden University
- Date
- 2017-10-26
- ISBN (print)
- 9789462336315
Funding
- Sponsorship
- Reumafonds, AbbVie B.V., Pfizer B.V., UCB Pharma B.V., Chipsoft B.V., Alrijne Zorggroep