Trial reportMedicine2016
High remission and low relapse with prolonged intensive DMARD therapy in rheumatoid arthritis (PRINT): A multicenter randomized clinical trial.
Trial report in Medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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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
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- [S2e guideline: treatment of rheumatoid arthritis with disease-modifying drugs].Zeitschrift fur Rheumatologie · 2018Guideline
- Comparison between leflunomide and sulfasalazine based triple therapy in methotrexate refractory rheumatoid arthritis: an open-label, non-inferiority randomized controlled trial.Rheumatology international · 2022Trial
- Efficacy and safety of low-dose interleukin-2 in combination with methotrexate in patients with active rheumatoid arthritis: a randomized, double-blind, placebo-controlled phase 2 trial.Signal transduction and targeted therapy · 2022Trial
- Development and Validation of the Medication Adherence Scale for Iraqi Patients with Rheumatoid Arthritis (MASIPRA): A Cross-Sectional Study.Patient preference and adherence · 2026Article
- Rheumatoid Arthritis-Associated Shoulder Rice Body Bursitis: Arthroscopic Management and Mechanistic Implications.The American journal of case reports · 2025Article
- Investigating the safety and compliance of using csDMARDs in rheumatoid arthritis treatment through face-to-face interviews: a cross-sectional study in China.Clinical rheumatology · 2021Article
- 2018 Chinese Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis.Rheumatology and immunology research · 2021Article
- Risk of higher dose methotrexate for renal impairment in patients with rheumatoid arthritis.Scientific reports · 2020Article
- Genetic and clinical prediction models for the efficacy and hepatotoxicity of methotrexate in patients with rheumatoid arthritis: a multicenter cohort study.The pharmacogenomics journal · 2020Article
- Clinical Practice Guideline forFrontiers in pharmacology · 2020Article
- Clinical deep remission and related factors in a large cohort of patients with rheumatoid arthritis.Chinese medical journal · 2019Article
- How to Get the Most from Methotrexate (MTX) Treatment for Your Rheumatoid Arthritis Patient?-MTX in the Treat-to-Target Strategy.Journal of clinical medicine · 2019Article
- Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis.Inflammopharmacology · 2016Review
Corrections and comments
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Authors and funding
25 authors at 14 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether prolonged intensive disease-modifying antirheumatic drug (DMARD) treatment (PRINT) leads to high remission and low relapse rates in patients with severe rheumatoid arthritis (RA).
methodsIn this multicenter, randomized and parallel treatment trial, 346 patients with active RA (disease activity score (28 joints) [DAS28] (erythrocyte sedimentation rate [ESR]) > 5.1) were enrolled from 9 centers. In phase 1, patients received intensive treatment with methotrexate, leflunomide, and hydroxychloroquine, up to 36 weeks, until remission (DAS28 ≤ 2.6) or a low disease activity (2.6 < DAS28 ≤ 3.2) was achieved. In phase 2, patients achieving remission or low disease activity were followed up with randomization to 1 of 2 step-down protocols: leflunomide plus hydroxychloroquine combination or leflunomide monotherapy. The primary endpoints were good European League Against Rheumatism (EULAR) response (DAS28 (ESR) < 3.2 and a decrease of DAS28 by at least 1.2) during the intensive treatment and the disease state retention rate during step-down maintenance treatment. Predictors of a good EULAR response in the intensive treatment period and disease flare in the maintenance period were sought.
resultsA good EULAR response was achieved in 18.7%, 36.9%, and 54.1% of patients at 12, 24, and 36 weeks, respectively. By 36 weeks, 75.4% of patients achieved good and moderate EULAR responses. Compared with those achieving low disease activity and a high health assessment questionnaire (HAQ > 0.5), patients achieving remission (DAS28 ≤ 2.6) and low HAQ (≤ 0.5) had a significantly higher retention rate when tapering the DMARDs treatment (P = 0.046 and P = 0.01, respectively). There was no advantage on tapering to combination rather than monotherapy.
conclusionsRemission was achieved in a proportion of patients with RA receiving prolonged intensive DMARD therapy. Low disease activity at the start of disease taper leads to less subsequent flares. Leflunomide is a good maintenance treatment as single treatment.
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