Teitsma XM, et al. - The goal of this research was to assess the progression of erosions and joint space narrowing (JSN) in feet and hands in the U-Act-Early trial. Findings demonstrated that initiating a tocilizumab-based treat-to-target strategy vs initiation of a step-up MTX strategy resulted in more inhibition of the progression of erosions, especially in the feet, in DMARD-naïve early RA patients.

Methods

• Researchers included a total of 317 newly diagnosed DMARD-naïve RA patients in this trial.
• Participants initiated randomly tocilizumab, or step-up MTX or a combination of the two.
• Using the Sharp–van der Heijde erosion and JSN score, researchers scored radiographs at baseline and after 52 and 104 weeks.
• Furthermore, between the strategy arms, changes from baseline and the proportions of patients without radiographic progression (change from baseline ≤ 0) were compared.

Results

• Findings demonstrated that the mean changes from baseline in erosion and JSN scores for the whole study population were after 52 weeks 0.59 and 0.18 and after 104 weeks 0.70 and 0.50, respectively.
• It was highlighted that for JSN, at both time points no differences in progression were found between strategies (P ⩾ 0.09).
• Researchers found that for erosions, the progression was significantly lower at week 104 in both tocilizumab arms when compared with the MTX arm ((p≤0.023).
• In both tocilizumab arms, they found less progression of erosions in the feet after 104 weeks (P ⩽ 0.046); this was not significant for the hands (P ⩾ 0.11).
• In addition, data reported that the proportion of patients without progression in erosions was higher in the tocilizumab arms at week 52 (tocilizumab plus MTX: 87%, P=0.038; tocilizumab: 81%, P=0.29) and 104 (tocilizumab plus MTX: 85%, P=0.001; tocilizumab: 77%, P=0.028), compared with the MTX arm (74 and 60%, respectively).