{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:26:24Z","timestamp":1791851184271,"version":"4.3.4"},"reference-count":33,"publisher":"The Journal of Rheumatology","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To examine the clinical and ultrasonographic (US) outcomes of reducing methotrexate (MTX) dosage upon initiating adalimumab (ADA) in MTX-inadequate responders with moderately to severely active rheumatoid arthritis (RA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>MUSICA (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01185288\">NCT01185288<\/jats:ext-link>) was a double-blind, randomized, parallel-arm study of 309 patients with RA receiving MTX \u2265 15 mg\/week for \u2265 12 weeks before screening. Patients were randomized to high dosage (20 mg\/week) or low dosage (7.5 mg\/week) MTX; all patients received 40 mg open-label ADA every other week for 24 weeks. The primary endpoint was Week 24 mean 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) to test for noninferiority of low-dosage MTX using a 15% margin. US images were scored using a 10-joint semiquantitative system incorporating OMERACT definitions for pathology, assessing synovial hypertrophy, vascularity, and bony erosions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Rapid improvement in clinical indices was observed in both groups after addition of ADA. The difference in mean DAS28-CRP (0.37, 95% CI 0.07\u20130.66) comparing low-dosage (4.12, 95% CI 3.88\u20134.34) versus high-dosage MTX (3.75, 95% CI 3.52\u20133.97) was statistically significant and non-inferiority was not met. Statistically significant differences were not detected for most clinical, functional, and US outcomes. Pharmacokinetic and safety profiles were similar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>In MUSICA, Week 24 mean DAS28-CRP, the primary endpoint, did not meet non-inferiority for the low-dosage MTX group. Although the differences between the 2 MTX dosage groups were small, our study findings did not support routine MTX reduction in MTX inadequate responders initiating ADA.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.151009","type":"journal-article","created":{"date-parts":[[2016,6,16]],"date-time":"2016-06-16T04:57:22Z","timestamp":1466053042000},"page":"1480-1489","source":"Crossref","is-referenced-by-count":39,"title":["Methotrexate Dosage Reduction Upon Adalimumab Initiation: Clinical and Ultrasonographic Outcomes from the Randomized Noninferiority MUSICA Trial"],"prefix":"10.3899","volume":"43","author":[{"given":"Gurjit S.","family":"Kaeley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M.","family":"Evangelisto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Midori J.","family":"Nishio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra L.","family":"Goss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shufang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmina","family":"Kalabic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Kupper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2016,6,15]]},"reference":[{"key":"2018112909360430000_43.8.1480.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.126532"},{"key":"2018112909360430000_43.8.1480.2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21641"},{"key":"2018112909360430000_43.8.1480.3","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199907)42:7<1322::AID-ANR4>3.0.CO;2-P"},{"key":"2018112909360430000_43.8.1480.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/36.1.86"},{"key":"2018112909360430000_43.8.1480.5","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.066662"},{"key":"2018112909360430000_43.8.1480.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61000-4"},{"key":"2018112909360430000_43.8.1480.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.21519"},{"key":"2018112909360430000_43.8.1480.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15640-7"},{"key":"2018112909360430000_43.8.1480.9","doi-asserted-by":"publisher","DOI":"10.1002\/art.20217"},{"key":"2018112909360430000_43.8.1480.10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201247"},{"key":"2018112909360430000_43.8.1480.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.cult.2008.02.001"},{"key":"2018112909360430000_43.8.1480.12","first-page":"48","article-title":"Is it possible to predict radiological damage in early rheumatoid arthritis (RA)? 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