Characterising deviation from treat-to-target strategies for early rheumatoid arthritis: the first three years

Table 1 Algorithm for treat-to-target disease-modifying anti-rheumatic drug (DMARD) therapy

Follow up, weeks*	DMC fulfilled ¹	Medications
Follow up, weeks*	DMC fulfilled ¹	Methotrexate (MTX)	Hydroxychloroquine (HCQ)	Sulfasalazine (SSZ)	Other DMARDs
0		10 mg/wk oral²	400 mg/d	0.5 g/d to 2.0 g/d³
6	Yes	10 mg/wk oral²	400 mg/d	3.0 g/d
12	Yes	15 mg/wk oral²	400 mg/d	3.0 g/d
18	Yes	20 mg/wk oral²	400 mg/d	3.0 g/d
24	Yes	25 mg/wk oral⁴	400 mg/d	3.0 g/d
30	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 10 mg^#
36	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg
42	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg + gold inj 50 mg/wk
48	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg + gold inj 50 mg/wk + Cyclosporine A 2.5 mg/kg^5#
54	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg + gold inj 50 mg/wk + Cyclosporine A 3 mg/kg
60	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg + gold inj 50 mg/wk + Cyclosporine A 4 mg/kg^#
66	Yes	25 mg/wk inj	400 mg/d	3.0 g/d	LFN 20 mg + gold inj 50 mg/wk + Cyclosporine A 4 mg/kg + azathioprine 1-2 mg/kg^#
72	Yes	If an inadequate response has occurred after 3 months, treatment failure

*Patients were reviewed at least every 6 weeks and therapy was increased if the treatment target had not been reached. Weeks of follow up are listed in the case of continued disease activity and hence increase in therapy at every visit. ^#Biological DMARDs can be added, if Pharmaceutical Benefits Scheme criteria are fulfilled. ¹If dose modification criteria (DMC) are not fulfilled, treatment is not modified; ²MTX administered parenterally if gastrointestinal side effects, ³starting dose 0.5 g/d and then increased by 0.5 g/d at weekly intervals to 2 g/d; ⁴maximum dose of MTX was based on weight and renal function: if weight <50 kg and/or creatinine clearance >30 but <60, MTX 20 mg/wk orally or parenterally, and if weight >50 kg and creatinine clearance >60 ml/min, MTX 25 mg/kg orally or parenterally. DMC, dose modification criteria; LFN, leflunomide; inj, injection.

ISSN: 1478-6362