Perhaps the results would have been different if the 'optimal' dosing strategy had been applied. Some would consider MTX 25mg sc, to a more appropriate comparator; I do acknowledge that most RCT's do not utilize 'optimal dosing' of MTX, despite most guidelines supporting their use. Unfortunately, statements by bodies such as NICE, that do not endorse MTXsc, are based on the absence of RCT's to determine/demonstrate its efficacy.