Combination therapy more effective in early RA
In the treatment of early rheumatoid arthritis (RA), a combination of anti-RA drugs is superior to methotrexate alone, UK researchers report.
“Our study,” lead investigator Dr. Ernest H. Choy told Reuters Health, “confirmed that there is a window of opportunity in the treatment of rheumatoid arthritis.”
Choy of King’s College School of Medicine, London and colleagues randomly assigned 467 patients with early RA to treatment with methotrexate alone or with the addition of another “disease-modifying antirheumatic drug” (cyclosporine) or the steroid prednisolone, or both, for 9 months.
In the 379 patients evaluated at 2 years, the researchers found that 29 percent of patients taking methotrexate alone developed new erosions, a sign of worsening disease.
Patients taking combination therapy fared better, with 17 percent in those who added cyclosporine, 16 percent of those who added prednisolone, and 13 percent of those on triple therapy showing signs of worsening disease.
Adding either a 9-month course of cyclosporine or a steroid to methotrexate can reduce joint damage by 50 percent compared with methotrexate alone, “which is the current standard,” Choy noted.
Triple therapy also reduced disability and increased quality-of-life compared to monotherapy. While more patients withdrew from the triple therapy group because of side effects, the incidence of serious adverse events was similar across groups.
The investigators conclude that early intensive combination therapy can produce sustained benefits in terms of damage and disability in patients with RA.
SOURCE: Annals of the Rheumatic Diseases, May 2008.
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