Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort

Table 1 Treatment protocol

Follow-up	DAS28	Medication
Week 0	≥ 2.6	Methotrexate 15 mg/wk
Week 8	≥ 2.6	Methotrexate 25 mg/wk
Week 12	≥ 2.6	Methotrexate 25 mg/wk + sulfasalazine 2,000 mg/day
Week 20	≥ 2.6	Methotrexate 25 mg/wk + sulfasalazine 3,000 mg/day
Week 24	≥ 3.2†	Methotrexate 25 mg/wk + adalimumab 40 mg every 2 weeks
Week 36	≥ 2.6 and decrease of > 1.2‡	Methotrexate 25 mg/wk + adalimumab 40 mg/week
Week 52	≥ 3.2†	Methotrexate 25 mg/wk + etanercept 50 mg/week
1 year + 3 months	≥ 3.2†	Methotrexate 25 mg/wk + infliximab 3 mg/kg every 8 weeks (after a loading dose at weeks 0, 2 and 6)
1 year + 6 months	≥ 2.6 and decrease of > 1.2‡	Methotrexate 25 mg/wk + infliximab 3 mg/kg every 4 weeks

The goal of treatment was remission (Disease Activity Score in 28 joints (DAS28) < 2.6). Treatment was intensified when this target was not met. In case of remission, medication was not changed. † Following the guidelines of the Dutch Society of Rheumatology and Dutch reimbursement regulations, anti-tumor necrosis factor α (anti-TNFα) therapy could be prescribed to patients with at least moderate disease activity (DAS28 ≥ 3.2) and in whom treatment with at least two disease-modifying antirheumatic drugs had failed (including methotrexate at 25 mg/week). ‡ Anti-TNFα therapy could be continued only if the DAS28 had decreased by > 1.2 after three months.

ISSN: 1478-6362