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RA Strategy: Treat Early, but With What Medicines?

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Triple DMARDs Vs. Anti-TNFs

The triple DMARD treatment gives results similar to biologic drugs known as anti-TNFs (anti-tumor necrosis factor agents). This was true whether patients used the drugs in combination with methotrexate from the beginning, or if they added them 6 months later as a next step.

A benefit of the triple therapy: It’s less expensive, says researcher Kaleb Michaud, PhD, an assistant professor at the University of Nebraska Medical Center. Michaud looked at how cost-effective the treatments were. He also at looked at the patients’ quality of life. While all strategies worked equally well, the triple strategies were most cost-effective over the long term. The biologics cost nearly twice as much, Michaud says. In the future, this information could help doctors and their patients choose treatment options when cost is an issue.  

Choosing RA Drugs

In the U.S., rheumatologists typically choose single therapy first if the disease is in early stages, says Eric Ruderman, MD. He is a professor of medicine at Northwestern University Feinberg School of Medicine. He reviewed the new research. If that’s not working, many rheumatologists will then add a biologic (usually injected), then if necessary a triple DMARD regimen with a biologic, he says.

"Initial triple DMARD therapy is a very hard sell," Ruderman says. The regimen includes about 50 pills a week, he says.

Many patients balk at that number, he says. They prefer to start with a single medication and see if that controls the disease.

Ruderman reports doing consulting work for several pharmaceutical companies.

The new research ''suggests we need to be treating RA more aggressively early," Nola says. Figuring out the exact medication or medications, she says, must be tailored to the patient.  

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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