Maxime Verhoeven

89 TCZ vs. TCZ+MTX; prevention of radiographic progression in RA cut-off for radiographic progression, 15 however, as only a few patients met this criterion, meaningful analyses were not possible. Despite these limitations, the current study used IPD of multiple RCTs, containing information of over 1500 RA patients, which provided an exclusive opportunity to explore radiographic progression in patients treated with TCZ with or without MTX in more detail. Conclusion For the majority of patients, TCZ combination therapy with MTX is more effective in preventing radiographic progression compared to TCZ-monotherapy. However, in early RA patients with more joint damage and/or lower DAS28 at baseline and in established RA patients with longer disease duration, the effectiveness of TCZ-monotherapy might approximate that of TCZ+MTX. In these specific subgroups, TCZ+MTX combination therapy might have no additional advantage regarding prevention of radiographic progression. REFERENCES 1. Smolen, J. S., Aletaha, D. & McInnes, I. B. Rheumatoid arthritis. Lancet 388 , 2023–2038 (2016). 2. van der Heijde, D. & Landewé, R. Should radiographic progression still be used as outcome in RA ? Clin. Immunol. 186 , 79–81 (2018). 3. Carpenter, L. et al. Have radiographic progression rates in early rheumatoid arthritis changed? A systematic review and meta-analysis of long-term cohorts. Rheumatol. 55 , 1053–1065 (2016). 4. Smolen, J. S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann. Rheum. Dis. 79 , 685–699 (2020). 5. Combe, B., Lula, S., Boone, C. & Durez, P. Effects of biologic disease-modifying anti-rheumatic drugs on the radiographic progression of rheumatoid arthritis: a systematic literature review. Clin. Exp. Rheumatol. 36 , 658–667 (2018). 6. Huizinga, T. W. J. et al. Clinical and radiographic outcomes at 2 years and the effect of tocilizumab discontinuation following sustained remission in the second and third year of the ACT-RAY study. Ann. Rheum. Dis. 74 , 35–43 (2015). 7. Burmester, G. R. et al. Tocilizumab combination therapy or monotherapy or methotrexate monotherapy in methotrexate-naive patients with early rheumatoid arthritis: 2-year clinical and radiographic results from the randomised, placebo-controlled FUNCTION trial. Ann. Rheum. Dis. 76 , 1279–1284 (2017). 8. Kaneko, Y. et al. Tocilizumab discontinuation after attaining remission in patients with rheumatoid arthritis who were treated with tocilizumab alone or in combination with methotrexate: results from a prospective randomised controlled study (the second year of the SURPRISE study). Ann. Rheum. Dis. 77 , 1268–1275 (2018). 9. Bijlsma, J. W. J. et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet. 388 , 343–355 (2016). 5