BERLIN - June 11, 2004 - Researchers at the annual meeting of the European Congress of Rheumatology (EULAR) reported preliminary findings from the BeSt trial, A multicenter, randomized, single blind trial in 508 patients with newly diagnosed (<2 years) rheumatoid arthritis (RA).

One goal of the BeSt trial is to determine the optimal use of TNF antagonists for RA. The purpose of the study is to compare the clinical and radiological outcomes in 4 different treatment strategies:

1. Sequential monotherapy - starting with methotrexate and sequentially switching to sulfasalazine, then leflunomide, then methotrexate plus a biologic

2. Step-up therapy from methotrexate - adding sulfasalazine and then hydroxylchloroquine

3. Step-down therapy from combination DMARD - starting with methotrexate plus sulfasalazine plus prednisone

4. Methotrexate plus biologic (infliximab) - followed by a switch to other DMARDs if response is not optimal

Patients received 3 monthly treatment adjustments, with the intended goal of achieving DAS44 <= 2.4. Patients in group 3 (Combination DMARD treatment) and group 4 (methotrexate plus biologic) had more rapid response (reduction in HAQ) and significantly less radiological damage than patients in groups 1 or 2. There were no significant differences in discontinuation rates or the incidence of adverse events between the groups.

According to Ferdinand C. Breedveld, MD - a Professor of Rheumatology at the University of Leiden, and an investigator for the BeSt trial - the optimal use of TNF antagonsists is with concomitant methotrexate, and rheumatologists should be confident that efficacy observed in clinical trials means effectiveness in everyday clinical practice.

A COMPARISON OF CLINICAL AND RADIOLOGICAL OUTCOMES OF FOUR TREATMENT STRATEGIES FOR EARLY RHEUMATOID ARTHRITIS: RESULTS OF THE BEST TRIAL.

JK De Vries-Bouwstra, YPM. Goekoop-Ruiterman, D Van Zeben, FC Breedveld, BA C. Dijkmans, JMW. Hazes, AH. Zwinderman, JHL. M. Van Groenendael, ML. Westedt, PJS. M. Kerstens, CF. Allaart, BeSt Trial Group.