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Standard RA Therapy as Good as Costlier Newcomer?

Biologic drug Enbrel wasn't better for patients who didn't respond to methotrexate alone
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About 20 percent to 40 percent of patients don't respond methotrexate or can't take the drug either because of side effects or it is not indicated for them, said Reddy, who was not involved in the study.

The findings are "reassuring," in that when a biologic is not an option, due to cost or other reasons, the older regimen is effective, she said.

Which regimen is best really needs to be tailored to each patient, Reddy said.

For the study, researchers randomly assigned 353 patients to methotrexate, sulfasalazine and hydroxychloroquine or to methotrexate and etanercept for 48 weeks. Some patients switched from one regimen to another midway through the study.

The researchers found that both groups improved significantly, with no difference between the two treatments.

In addition, improvements in both groups were similar with regard to pain, quality of life, progression of their arthritis as seen on X-rays or side effects of the drugs.

For her part, Dr. Diane Horowitz, a rheumatologist at North Shore University Hospital, in Manhasset, N.Y., said the trial wasn't long enough to really tell if treatment with etanercept is equal to the three-drug regimen.

"In other studies, people on biologics did better over the long term," said Horowitz, who is also with the LIJ Medical Center, in New Hyde Park, N.Y. "I want to see more long-term data."

For patients who don't do well on methotrexate alone "there is some significant evidence that doing methotrexate plus sulfasalazine plus hydroxychloroquine [gives] a good response, and you don't always have to jump to a biologic right away," she said.

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