Randomised clinical trials of bDMARDs and tsDMARDs in combination with methotrexate compared with methotrexate alone in methotrexate-naïve patients with RA with disease duration <1 year
| Mechanism of action | bDMARD or tsDMARD | Year of publication | RA disease duration according to the inclusion criteria | % of patients achieving remission in the combination arm | % of patients achieving remission in the methotrexate monotherapy arm | Time-point | Corticosteroid use |
| TNF inhibition | Infliximab (IDEA)28 | 2014 | 3–12 months | 40.6 | 50.8 | Week 26 | Single intravenous methylprednisolone in MTX arm only |
| TNF inhibition | Adalimumab (OPERA)21 | 2014 | <6 months | 74 | 49 | 1 year | Intra-articular corticosteroids |
| Costimulation inhibitor | Abatacept (AVERT)24 | 2015 | ~0.6 years (symptom duration <2 years) | 60.9 | 45.2 | 6 months | <10 mg/day |
| TNF inhibition | Certolizumab pegol (C-EARLY)22 | 2017 | <1 year | 29 | 15 | 1 year | ~30% of patients,<10 mg/day |
| IL6-R blockade | Tocilizumab (U-Act-Early)15 | 2016 | <1 year | 86 | 44 | 2 years | Not permitted |
bDMARDs, biologic DMARDs; DMARDs, disease-modifying antirheumatic drugs; IL6-R, interleukin 6 receptor; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumor necrosis factor; tsDMARDs, targeted synthetic DMARDs.