Sana Rheumazentrum Baden-Wrttemberg, Germany, comments : "Studies examining early versus delayed onset of immunosuppressive treatment and high versus low initial intensity of treatment suggest that effective treatment needs to be started during a critical time early in the course of the disease. During this window of opportunity, inflammation seems to be particularly susceptible to treatment and long-term preservation of structure and function probably relies heavily on the initiation of effective immunosuppression during this particular time span. Most trials involving antagonists of tumour necrosis factor, including ATTRACT, ARMADA, and TEMPO, comprised patients with disease of several years' duration. The next generation of trials will target patients with recent onset of disease and these trials are essential to support, or refute, the concept of the window of opportunity. If timing turns out to be the critical factor it seems to be, the benefits of disease-modifying antirheumatic drugs, biologicals, and the various combinations thereof will need to be reassessed."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
26-Feb-2004

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