Maxime Verhoeven

116 Chapter 6 period up to 5 years. Although during the follow-up radiographs available at a previous visit could be used for our analyses, still 17% of radiographs in the TCZ+MTX group, 33% in the TCZ group and 21% in the MTX group were missing. Finally, quality of life was not assessed, as well as data about comorbidity. Conclusion The high effectiveness of the treat-to-target treatment strategies during the U-Act-Early trial period of 2 years was maintained during the 3-year PTFU in a real-world setting. Although during the 2-year trial period TCZ-based initiation strategies yielded the most clinical benefit, in the following 3 years differences in important clinical outcomes between initial strategies disappeared, probably due to continuation of the treat-to- target principle, frequently leading to a convergence of treatment regimens. bDMARD use remained higher in the strategy groups initiating TCZ early, possibly due to the lack of a protocolized tapering strategy after the U-Act-Early trial. All treatment strategies proved to be safe. REFERENCES 1. Smolen, J. S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis. 76 , 960–977 (2017). 2. St.Clair, E. W. et al. Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum. 50 , 3432–3443 (2004). 3. Quinn, M. A. et al. Very early treatment with infliximab in addition to methotrexate in early, poor- prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal. Arthritis Rheum. 52 , 27–35 (2005). 4. Tak, P. P. et al. Sustained inhibition of progressive joint damage with rituximab plus methotrexate in early active rheumatoid arthritis: 2-year results from the randomised controlled trial IMAGE. Ann. Rheum. Dis. 71 , 351–357 (2012). 5. Detert, J. et al. Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naïve patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann. Rheum. Dis. 72 , 844–850 (2013). 6. Burmester, G. R. et al. Tocilizumab in early progressive rheumatoid arthritis: FUNCTION, a randomised controlled trial. Ann. Rheum. Dis. 75 , 1081–1091 (2016). 7. Goekoop-Ruiterman, Y. P. M. et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 52 , 3381–3390 (2005). 8. Takeuchi, T. et al. Adalimumab, a human anti-TNF monoclonal antibody, outcome study for the prevention of joint damage in Japanese patients with early rheumatoid arthritis: the HOPEFUL 1 study. Ann. Rheum. Dis. 73 , 536–543 (2014). 9. Singh, J. A. et al. Biologics or tofacitinib for people with rheumatoid arthritis naive tomethotrexate: a systematic review and network meta-analysis. Cochrane Database Syst. Rev. 2017 , CD012657 (2017).