Team: NORD-STAR, aka the “NORD All Stars”

Base Article: Østergaard M, van Vollenhoven RF, Rudin A, et al. Certolizumab pegol, abatacept, tocilizumab or active conventional treatment in early rheumatoid arthritis: 48-week clinical and radiographic results of the investigator-initiated randomised controlled NORD-STAR trial. Ann Rheum Dis. 2023;82(10):1286-1295. doi:10.1136/ard-2023-224116

Authors: Vanderbilt Rheumatology Fellowship Program

1. Michael Libre, medical student, Vanderbilt University School of Medicine
2. Yash Pershad, medical student, Vanderbilt University School of Medicine
3. Genessis Maldonado, MD, Fellow, Division of Rheumatology and Immunology, Vanderbilt University Medical Center
4. Tyler Reese, MD, Assistant Professor of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center

Team Overview

Rheumatoid arthritis (RA) treatment is more divisive than Christian Laettner.

The Scandinavian NORD-STAR trial demonstrated that crossing up RA treatment paradigms by starting with biologics can do more than just break the ankles of RA – first line biologics can euro-step their way to superior clinical remission rates than conventional therapy.

In NORD-STAR, active conventional treatment and biologics faced off head-to-head for the first time in treatment-naïve RA. The star-studded final four included the seasoned veteran active conventional therapy and the rising stars abatacept, certolizumab, and tocilizumab.

In a 48-week matchup, abatacept and certolizumab left conventional therapy behind on fast-breaking the pain and stiffness of RA. They threw down slam dunks, significantly outperforming active conventional therapy in achieving 48-week clinical remission. Although tocilizumab got close to hitting a buzzer-beater, it didn’t quite statistically outshine active conventional therapy in the box score. When it came to guarding against radiographic progression, it was a tie game—everybody on the NORD-STAR court proved they could block advancement of structural joint damage.

When it comes to picking the most “practically perfect” paper, bracketologists will want to check the advanced stats: RA affects 1.3 million Americans and is among the most common concerns a rheumatologist will manage day-to-day.

Although this year’s challengers are fierce, you’ll want to bet on this early RA game-changer. Even if you love to root for the mid-majors focusing on individual RA therapies or the Cinderellas making advancements in rarer diseases, betting on NORD-STAR is as good as betting on Coach K.

Want to learn more?

See the Q&A on theMednet.org about the following question: How do you approach selecting biologic therapy vs non-biologic DMARD (such as methotrexate) as initial therapy in patients with new RA diagnosis with significant erosive disease?

Next Report: RA-ILD Review

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