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Treating to Target Matrix
Metalloproteinase 3 Normalisation Together with Disease Activity
Score Below 2.6 Yields Better Effects Than Each Alone In Rheumatoid
Arthritis Patients: Treating to Twin Targets; T-4
Study
Yukitomo Urata
1, Ryoko Uesato1, Dai
Tanaka1, Yoshihide Nakamura2 and Shigeru
Motomura2, 1Seihoku Chuo Hospital,
Gosyogawara, Japan, 2Hirosaki University Graduate School
of Medicine, Hirosaki, Japan
Presentation Number:
1207
Background/Purpose: To assess whether
therapy to achieve both disease activity score in 28 joints (DAS28)
<2.6 and matrix metalloproteinase (MMP)-3
normalisation offers better outcomes than either target alone in
early rheumatoid arthritis at 56 weeks; Treating to twine targets;
T-4 study.
Method: A total of 243
early RA patients were randomly allocated to one of four strategy
groups: routine care (R group; n=62); DAS28-driven therapy (D
group; n=60); MMP-3-driven therapy (M group; n=60); or both DAS28-
and MMP-3-driven therapy group (Twin; T group; n=61). Specifically,
medication was started with sulfasalazine (1 g/day) in all
intervention groups. Targets were DAS28 <2.6 for D
group, MMP-3 normalisation for M group, and both DAS28
<2.6 and MMP-3 normalisation for T group. If the
value in question did not fall below the previously measured level,
we intensified medication including methotrexate, other
disease-modifying anti-rheumatic drugs and biologic agents.
Primary, secondary, tertiary and quaternary outcome measures
consisted of the proportions of patients in clinical remission
(DAS28 <2.6), showing radiographic nonprogression
(Dmodified total Sharp score
≤0.5), showing normal physical
function (modified Health Assessment Questionnaire score=0), and
comprehensive disease remission defined as the combination of
clinical remission, radiographic nonprogression, and structural
normal physical function.
Results: Comprehensive
disease remission at 56 weeks was achieved by more patients in T
group (34%) than in R group (p<0.001), D group
(p<0.05), or M group
(p<0.001).
Conclusion: Results of the
T-4 study revealed that comprehensive disease remission is an
achievable goal in early RA with more aggressive
therapy.
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RA患者中基质金属蛋白酶3正常和疾病活动指数小于2.6的双重达标比单一达标疗效更好：T-4双标准研究
Yukitomo Urata , et al. ACR 2011. Present No:
1207
背景/目的:评估在早期RA患者治疗56周的T-4研究中，DAS28< 2.6和基质金属蛋白酶3(MMP)3正常化的同时达标是否比单一达标的疗效更好。
方法:共243例早期RA患者随机分配到四个治疗组:常规治疗组(R组;n =
62);DAS28-目标组(D组;60例);MMP-3-目标组(M组;60例),或DAS28和MMP-3双目标组(双标准,T组;n =
61)。具体而言,所有干预组都从硫氮磺氨吡碇开始(1 g /日)
。目标为D组DAS28< 2.6,M组MMP-3正常化,T组同时满足上述两个条件。如果测量值未达到上述标准,就需要强化治疗药物包括甲氨喋呤治疗、其它抗风湿病药和生物制剂。第一、二、三级和四级疗效评价标准包括:临床缓解（DAS28< 2.6),放射学无进展 (改良的总Sharp积分≤0.5), 正常生理功能(改良的健康评估问卷得分=
0), 疾病全面缓解（为临床、影像学、和结构功能正常的综合评估）的患者比例。
结果:56周时达到全面缓解的患者比例在T组为34%,明显高于R组(p
< 0.001),D组(p < 0.05),或M组(p
< 0.001)。
结论:
T-4研究结果显示, 更积极的治疗完全可以使早期RA达到疾病全面缓解。
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