Table 1

Treatment protocol

Follow-up

DAS28

Medication


Week 0

≥ 2.6

Methotrexate 15 mg/wk

Week 8

≥ 2.6

Methotrexate 25 mg/wk

Week 12

≥ 2.6

Methotrexate 25 mg/wk + sulfasalazine 2,000 mg/day

Week 20

≥ 2.6

Methotrexate 25 mg/wk + sulfasalazine 3,000 mg/day

Week 24

≥ 3.2†

Methotrexate 25 mg/wk + adalimumab 40 mg every 2 weeks

Week 36

≥ 2.6 and decrease of > 1.2‡

Methotrexate 25 mg/wk + adalimumab 40 mg/week

Week 52

≥ 3.2†

Methotrexate 25 mg/wk + etanercept 50 mg/week

1 year + 3 months

≥ 3.2†

Methotrexate 25 mg/wk + infliximab 3 mg/kg every 8 weeks (after a loading dose at weeks 0, 2 and 6)

1 year + 6 months

≥ 2.6 and decrease of > 1.2‡

Methotrexate 25 mg/wk + infliximab 3 mg/kg every 4 weeks


The goal of treatment was remission (Disease Activity Score in 28 joints (DAS28) < 2.6). Treatment was intensified when this target was not met. In case of remission, medication was not changed. † Following the guidelines of the Dutch Society of Rheumatology and Dutch reimbursement regulations, anti-tumor necrosis factor α (anti-TNFα) therapy could be prescribed to patients with at least moderate disease activity (DAS28 ≥ 3.2) and in whom treatment with at least two disease-modifying antirheumatic drugs had failed (including methotrexate at 25 mg/week). ‡ Anti-TNFα therapy could be continued only if the DAS28 had decreased by > 1.2 after three months.

Vermeer et al. Arthritis Research & Therapy 2012 14:R254   doi:10.1186/ar4099

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