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In the 2012 “TEAR” trial (NEJM JW Gen Med Oct 23 2012), 755 patients with early rheumatoid arthritis and poor-prognosis features were randomized either to initial methotrexate monotherapy (with step-up to combination therapy if response was inadequate at 24 weeks) or to immediate combination therapy (either methotrexate plus etanercept, or methotrexate plus sulfasalazine plus hydroxychloroquine). Starting at around 36 weeks and extending through the second year of treatment, outcomes were similar with the two approaches.
Now, the researchers provide additional post hoc analysis. Among patients initially randomized to methotrexate monotherapy, 28% responded and continued monotherapy; during 2 years of follow-up, their disease activity scores …