Trial reportArthritis research & therapy2016
Two-year results of disease activity score (DAS)-remission-steered treatment strategies aiming at drug-free remission in early arthritis patients (the IMPROVED-study).
Trial report in Arthritis research & therapy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Down-titration and discontinuation strategies of tumour necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity.The Cochrane database of systematic reviews · 2019Pooled it
- Trial
- The trajectory of clinical responses in patients with early rheumatoid arthritis who achieve sustained remission in response to abatacept: subanalysis of AVERT-2, a randomized phase IIIb study.Arthritis research & therapy · 2023Trial
- Baseline autoantibody profile in rheumatoid arthritis is associated with early treatment response but not long-term outcomes.Arthritis research & therapy · 2018Trial
- Anti-Modified Protein Antibodies in Rheumatoid Arthritis: Pathogenic, Protective, or Passive Bystander?Immunological reviews · 2026Review
- Structural and Functional Outcomes in Rheumatoid Arthritis After 10-Year Therapy with Disease-Modifying Antirheumatic Drugs Under Tight Control: Evidence from Real-World Cohort Data.Journal of clinical medicine · 2025Article
- Exploring perinatal mesenchymal stromal cells as a potential therapeutic strategy for rheumatoid arthritis.Heliyon · 2025Review
- Biomarkers in the diagnosis, prognosis and management of rheumatoid arthritis: A comprehensive review.Annals of clinical biochemistry · 2025Review
- The prognostic value of IgA anti-citrullinated protein antibodies and rheumatoid factor in an early arthritis population with a treat-to-target approach.Immunologic research · 2024Article
- Long-term mortality in treated-to-target RA and UA: results of the BeSt and IMPROVED cohort.Annals of the rheumatic diseases · 2024Article
- Tailored therapeutic decision of rheumatoid arthritis using proteomic strategies: how to start and when to stop?Clinical proteomics · 2023Review
- Sustained Remission and Outcomes with Abatacept plus Methotrexate Following Stepwise Dose De-escalation in Patients with Early Rheumatoid Arthritis.Rheumatology and therapy · 2023Article
- From Bench to Bedside in Rheumatoid Arthritis from the "2022 GISEA International Symposium".Journal of clinical medicine · 2023Review
- Synovial tissue macrophages in joint homeostasis, rheumatoid arthritis and disease remission.Nature reviews. Rheumatology · 2022Review
- Defining the Optimal Strategies for Achieving Drug-Free Remission in Rheumatoid Arthritis: A Narrative Review.Healthcare (Basel, Switzerland) · 2021Review
- Article
- The number of risk factors for persistent disease determines the clinical course of early arthritis.Rheumatology (Oxford, England) · 2021Article
- The impact of different (rheumatoid) arthritis phenotypes on patients' lives.Rheumatology (Oxford, England) · 2021Article
- Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis.Arthritis & rheumatology (Hoboken, N.J.) · 2021Article
- Early DAS response after DMARD-start increases probability of achieving sustained DMARD-free remission in rheumatoid arthritis.Arthritis research & therapy · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 9 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly suppression of disease activity in (rheumatoid) arthritis (RA) patients may result in drug-free remission and prevent damage. We assessed 2-year clinical and radiological outcomes of two disease activity score (DAS)-remission-steered treatment strategies in early arthritis patients.
methodsPatients (n = 610) with early RA or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and tapered high dose of prednisone. Patients in early remission (44/53 joints DAS <1.6) after 4 months tapered and stopped medication. Patients who did not achieve early DAS-remission were randomized to either MTX plus hydroxychloroquine plus sulphasalazine plus low dose prednisone (arm 1) or to MTX + adalimumab (arm 2). At four-monthly intervals, medication was tapered and stopped if DAS was <1.6 but restarted, increased or switched if DAS was ≥1.6. Proportions of (drug-free) DAS-remission (DFR) after 2 years and Sharp-van der Heijde scores (SHS) were analyzed separately for the treatment strategies and patients with RA and UA.
resultsAfter 2 years, 301/610 (49 %) patients were in DAS-remission and 131/610 (21 %) in DFR. In the early remission group 241/387 patients (62 %) were in DAS-remission and 111/387 (29 %) DFR. In arm 1 22/83 (27 %) and in arm 2 24/78 (31 %) were in DAS-remission, and 6/83 (7 %) and 7/78 (9 %), respectively, were in DFR. RA and UA patients achieved DAS-remission in comparable percentages (RA: 234/479 (49 %), UA: 64/122 (52 %), p = 0.25). More UA patients achieved DFR (41/122 (34 %)) compared to RA patients (89/479 (19 %), p<0.001). Mean (SD) DAS over time was 1.74 (0.58) across all patients, and median (IQR) SHS progression was 0 (0-0).
conclusionsAfter 2 years remission-steered treatment in early RA and UA patients, DAS-remission and DFR percentages were relatively low. Patients who achieved early remission more often achieved (drug-free) remission after 2 years than patients who needed additional treatment steps in the randomization arms, and more UA than RA patients achieved DFR. Overall, disease activity and radiologic damage progression in all patients were well suppressed.
trial registrationhttp://www.controlled-trials.com/ISRCTN11916566 Registered 07/11/2006 and EudraCT number 2006-06186-16 Registered 16/07/2007.
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