Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial

RCT in 317 patients with newly diagnosed RA found strategies aimed at sustained remission by immediate initiation of tocilizumab with/without methotrexate are more effective, and with a similar safety profile, compared to initiation of methotrexate in line with current standards.

This findings show that 86% patients in the tocilizumab plus methotrexate arm achieved sustained remission on the initial regimen, compared with 84% in the tocilizumab arm, and 44% in the methotrexate arm (RR 2·00, 95% CI 1·59–2·51 for tocilizumab plus methotrexate vs methotrexate, and 1·86, 1·48–2·32 for tocilizumab vs methotrexate, p<0·0001 for both comparisons).

 

An editorial comments on these findings highlighting how the treatment strategies for patients with rheumatoid arthritis has shifted with the so-called inversion of the treatment pyramid improving outcomes by moving treatment beyond initial non-steroidal drugs to early methotrexate. The author suggests that the next step, as supported by the results of study, will be to move beyond methotrexate to initial intensive strategies which might include biologic drugs.