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Carol Eustice

Combination of DMARDs as Effective as Biologic Drug for Rheumatoid Arthritis

By June 12, 2013

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Study results, published in the June 11, 2013 issue of the New England Journal of Medicine, revealed that an older, conventional treatment regimen was just as effective as newer biologic drugs in rheumatoid arthritis patients who did not respond well to methotrexate alone. The older regimen consists of a combination of three disease-modifying anti-rheumatic drugs (DMARDs) -- methotrexate, sulfasalazine (Azulfidine) and hydroxychloroquine (Plaquenil).

The 48-week, double-blind, randomized clinical trial involved 353 people with rheumatoid arthritis who had active disease despite treatment with methotrexate alone. The patients were randomly assigned the combination therapy (methotrexate, sulfasalazine, and hydroxychloroquine) or Enbrel plus methotrexate. Patients who did not show improvement at 24 weeks were switched to the other treatment regimen without knowing. The primary outcome for the study was improvement in DAS28 at week 48. Results showed that both groups had significant improvement over the first 24 weeks. A total of 27% of participants in each group switched treatment at 24 weeks and had improvement after switching. Researchers concluded that the triple-drug combination therapy produced similar results to Enbrel plus methotrexate and was not an inferior treatment. A longer trial to confirm the results may be indicated.

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