Evidence map›Paper›PMID 17519278›Full record

Trial reportAnnals of the rheumatic diseases2007

Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial).

S M M Verstappen, J W G Jacobs, M J van der Veen, A H M Heurkens, Y Schenk, E J ter Borg, A A M Blaauw, J W J Bijlsma, Utrecht Rheumatoid Arthritis Cohort study group

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of the rheumatic diseases, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02260778 (Treat-to-target in RA), which is not on this map. Cited by 172 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
172citing papers in PubMed, 17 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02260778 nacompletednot on this mapstarted 2014, after this paper: background citation

Treat-to-target in RA: Collaboration To Improve adOption and adhereNce (TRACTION)

TypeinterventionalSponsorBrigham and Women's HospitalRan2014 to 2024Enrolled11ConditionsArthritis, RheumatoidArmsLearning Collaborative
3 · Its place in the literature

Who cites it

172 citing papers in PubMed, 17 syntheses or guidelines pooled it.

  1. Guideline
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  8. Computerized advice on drug dosage to improve prescribing practice.The Cochrane database of systematic reviews · 2013
    Pooled it
  9. My treatment approach to rheumatoid arthritis.Mayo Clinic proceedings · 2012
    Guideline
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  14. Guideline
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  16. Guideline
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  18. Trial
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112 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

S M M VerstappenUniversity Medical Center Utrecht, Utrecht, the Netherlands.
J W G Jacobs
M J van der Veen
A H M Heurkens
Y Schenk
E J ter Borg
A A M Blaauw
J W J Bijlsma
Utrecht Rheumatoid Arthritis Cohort study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo investigate whether intensive treatment with methotrexate (MTX) according to a strict protocol and a computerised decision program is more beneficial compared to conventional treatment with MTX in early rheumatoid arthritis.

methodsIn a two-year multicentre open label strategy trial, 299 patients with early rheumatoid arthritis were randomly assigned to the intensive strategy group or the conventional strategy group. Patients in both groups received MTX, the aim of treatment being remission. Patients in the intensive treatment group came to the outpatient clinic once every month; adjustment of the MTX dosage was tailored to the individual patient on the basis of predefined response criteria, using a computerised decision program. Patients of the conventional strategy group came to the outpatient clinic once every three months; they were treated according to common practice. Cyclosporine was added if patients had an inadequate response to maximal tolerated MTX doses.

resultsSeventy six (50%) patients in the intensive strategy group achieved at least one period of remission during the two year trial, versus 55 patients (37%) in the conventional strategy group (p = 0.03). Areas under the curve for nearly all clinical variables were significantly lower-that is, there was a better clinical effect for the intensive treatment group compared with the conventional treatment group.

conclusionThe results of this study show that it is possible to substantially enhance the clinical efficacy early in the course of the disease by intensifying treatment with MTX, aiming for remission, tailored to the individual patient. Furthermore, participating rheumatologists indicated that the computerised decision program could be a helpful tool in their daily clinical practice.

Indexed as

AdultAgedAntirheumatic AgentsArthritis, RheumatoidClinical ProtocolsDisease ProgressionDrug Administration ScheduleDrug MonitoringDrug Therapy, Computer-AssistedFemaleHumansMaleMethotrexateMiddle AgedRadiographyRemission InductionAntirheumatic AgentsMethotrexate

Identifiers

PMID17519278
PMCPMC2111604

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.