Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial

BMJ : British Medical Journal
David L ScottGabrielle Kingsley

Abstract

To determine whether intensive combinations of synthetic disease modifying drugs can achieve similar clinical benefits at lower costs to high cost biologics such as tumour necrosis factor inhibitors in patients with active rheumatoid arthritis resistant to initial methotrexate and other synthetic disease modifying drugs. Open label pragmatic randomised multicentre two arm non-inferiority trial over 12 months. 24 rheumatology clinics in England. Patients with rheumatoid arthritis who were eligible for treatment with tumour necrosis factor inhibitors according to current English guidance were randomised to either the tumour necrosis factor inhibitor strategy or the combined disease modifying drug strategy. Biologic strategy: start tumour necrosis factor inhibitor; second biologic in six month for non-responders. Alternative strategy: start combination of disease modifying drugs; start tumour necrosis factor inhibitors after six months in non-responders. reduction in disability at 12 months measured with patient recorded heath assessment questionnaire (range 0.00-3.00) with a 0.22 non-inferiority margin for combination treatment versus the biologic strategy. quality of life, joint damage, disease activity, adverse events, and cost...Continue Reading

Citations

Sep 25, 2015·Journal of Medical Economics·J HarnettJ Bourret
Jan 9, 2016·Journal of Crohn's & Colitis·Gionata FiorinoSilvio Danese
Nov 6, 2015·Mediators of Inflammation·Sylvie HermouetBetty Gardie
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Jun 21, 2017·Lancet·David L Scott, Matt D Stevenson
Sep 7, 2017·Journal of General Internal Medicine·Scott K AbereggMatthew H Samore
Feb 28, 2019·International Journal of Rheumatic Diseases·Chak Sing LauSwan Sim Yeap
Feb 7, 2019·International Journal of Technology Assessment in Health Care·Emma L SimpsonSalah Ghabri
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Nov 1, 2018·BMC Musculoskeletal Disorders·Catherine D HughesUNKNOWN TITRATE Programme Investigators
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Aug 20, 2021·Immunologic Research·Khalaf KridinArnon D Cohen

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