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

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

Follow up, weeks* DMC fulfilled 1 Medications
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/kg5#
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
  1. *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.