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

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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.

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。