Trial reportRheumatology (Oxford, England)2012
Aggressive therapy in patients with early arthritis results in similar outcome compared with conventional care: the STREAM randomized trial.
Trial report in Rheumatology (Oxford, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04985435 (Better After CHoosing. Randomly Allocated or Patient Preference Based Treatment With Filgotinib or TNFi in Patients With Active Rheumatoid Arthritis), which is not on this map. Cited by 15 papers, 2 of them syntheses that pooled 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.
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.
Better After CHoosing. Randomly Allocated or Patient Preference Based Treatment With Filgotinib or TNFi in Patients With Active Rheumatoid Arthritis (BACH)
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Intensive therapy and remissions in rheumatoid arthritis: a systematic review.BMC musculoskeletal disorders · 2018Pooled it
- Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update.Annals of the rheumatic diseases · 2016Pooled it
- Two-year results of disease activity score (DAS)-remission-steered treatment strategies aiming at drug-free remission in early arthritis patients (the IMPROVED-study).Arthritis research & therapy · 2016Trial
- Treat-to-target in Behçet syndrome.Nature reviews. Rheumatology · 2026Review
- Management of rheumatoid arthritis: 2019 updated consensus recommendations from the Hong Kong Society of Rheumatology.Clinical rheumatology · 2019Review
- Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target?Current rheumatology reports · 2018Review
- Future therapeutic targets in rheumatoid arthritis?Seminars in immunopathology · 2017Review
- Remission-induction therapies for early rheumatoid arthritis: evidence to date and clinical implications.Therapeutic advances in musculoskeletal disease · 2016Review
- MicroRNA-125b: association with disease activity and the treatment response of patients with early rheumatoid arthritis.Arthritis research & therapy · 2016Article
- Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force.Annals of the rheumatic diseases · 2016Review
- Rheumatoid arthritis: 2014 treat-to-target RA recommendations--strategy is key.Nature reviews. Rheumatology · 2015Article
- Early diagnosis of rheumatic diseases: an evaluation of the present situation and proposed changes.Reumatologia · 2015Article
- Circulating miRNA-125b is a potential biomarker predicting response to rituximab in rheumatoid arthritis.Mediators of inflammation · 2014Article
- Newest clinical trial results with antitumor necrosis factor and nonantitumor necrosis factor biologics for rheumatoid arthritis.Current opinion in rheumatology · 2013Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the effects of aggressive tight control therapy and conventional care on radiographic progression and disease activity in patients with early mild inflammatory arthritis.
methodsPatients with two to five swollen joints, Sharp-van der Heijde radiographic score (SHS) <5 and symptom duration ≤2 years were randomized between two strategies. Patients with a definite non-RA diagnosis were excluded. The protocol of the aggressive group aimed for remission (DAS < 1.6), with consecutive treatment steps: MTX, addition of adalimumab and combination therapy. The conventional care group followed a strategy with traditional DMARDs (no prednisone or biologics) without DAS-based guideline. Outcome measures after 2 years were SHS (primary), remission rate and HAQ score (secondary).
resultsEighty-two patients participated (60% ACPA positive). In the aggressive group (n = 42), 19 patients were treated with adalimumab. In the conventional care group (n = 40), 24 patients started with hydroxychloroquin (HCQ), 2 with sulfasalazine (SSZ) and 14 with MTX. After 2 years, the median SHS increase was 0 [interquartile range (IQR) 0-1.1] and 0.5 (IQR 0-2.5), remission rates were 66 and 49% and HAQ decreased with a mean of -0.09 (0.50) and -0.25 (0.59) in the aggressive and conventional care group, respectively. All comparisons were non-significant.
conclusionIn patients with early arthritis of two to five joints, both aggressive tight-control therapy including adalimumab and conventional therapy resulted in remission rates around 50%, low radiographic damage and excellent functional status after 2 years. However, full disease control including radiographic arrest in all patients remains an elusive target even in moderately active early arthritis. Trial registration. Dutch Trial Register, http://www.trialregister.nl/, NTR 144.
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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.