Drug Combo Best for Rheumatoid Arthritis
Combination Treatment Works Best for Preventing Future Complications
Oct. 28, 2005 -- Two or even three drugs are much better than one in
treating the early stages of rheumatoid arthritis and preventing future
complications, according to a new study.
Dutch researchers compared the four most recommended and widely used
prescription drug treatments for early rheumatoid arthritis (RA). The
researchers found that people treated with a combination therapy with
methotrexate (sold under Rheumatex and other brand names), and corticosteroids
or Remicade (infliximab) fared much better one year later than those treated
with methotrexate alone.
Researchers say two new classes of drugs, known as disease-modifying
antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) antagonists, have
changed the way rheumatoid arthritis is treated in recent years. Used early on,
studies have shown that these drugs have the potential to slow the progression
of joint damage.
But the best strategy and combinations for using the drugs to prevent
long-term joint damage and disability is unclear.
Rheumatoid Arthritis Treatments Face Off
In the study, researchers compared the effectiveness of the four most widely
prescribed drug treatments for early rheumatoid arthritis in 508 people, mostly
women, over the course of one year. Participants were ones with early RA who
had the disease for two years or less and who had not had prior treatment with
DMARDs. Other criteria for inclusion and exclusion of participants were based
on history of medical conditions, lab tests, and substance abuse.
The participants were divided into four groups and received one of the
following four treatments:
- Standard DMARD therapy: methotrexate alone.
- Step-up combination therapy: methotrexate alone to start followed by adding
other DMARDs and prednisone.
- Combination therapy with three drugs: methotrexate, Azulfidine, and taper
- Combination therapy with two drugs: methotrexate and Remicade.
At the end of the study, researchers used X-rays to measure joint damage and
disease progression as well as clinical exams to evaluate symptom
Patients With Best Results
The results showed that each treatment group showed measurable improvements,
and 32% of all participants experienced a remission of their disease.
But those who received initial combination therapy with methotrexate and
Remicade or prednisone had significantly less joint damage and progression of
their disease than those treated with methotrexate alone or those in the
step-up combination group.
"Patients in groups 3 and 4 had the benefit of a more rapid relief of
symptoms and improvement of physical function," says researcher B. A. C.
Dijkmans, MD, of VU Medical Center in Amsterdam, The Netherlands, in a news
release. "In addition, there is the possibility that effective suppression
of disease activity during the early phases of the disease may ameliorate the
long-term joint damage and poor physical function and, ideally, even induce
true clinical remission without the need for ongoing DMARD treatment."