Aggressive Combination Therapy Improves RA Disease Severity

Patients achieve drug-free remission with less expensive biologic drugs during first 2 years of treatment.

An aggressive treatment approach for rheumatoid arthritis (RA) may provide significant benefits for patients, a recent trial indicates.

The results of a study presented at the European League Against Rheumatism Annual Congress found that initial therapy with combination DMARDs significantly improves disease activity measures and functional ability for early RA. The results suggest an initial treatment regimen including methotrexate, sulfasalazine, and hydroxychloroquine may offer significant benefits compared with methotrexate monotherapy.

"Many trials have shown that early and intensive treatment can induce remission and prevent joint damage in patients with rheumatoid arthritis, yet often a step-wise approach of escalating treatment is preferred," lead author Angelique Weel, MD, said in a press release. "Our data showed an earlier decrease in disease severity and improvements in functional ability in the combination-therapy groups compared to monotherapy, adding to the evidence base for an intensive treatment approach early on.”

Following 3 months of treatment, improvements in the Health Assessment Questionnaire were significantly greater among the triple DMARD induction therapy cohort. This improvement remained significant through 2 years, regardless of disease activity.

Furthermore, joint damage progression was minimal and similar in both patient groups.

The trial included 281 RA patients randomized to treatment with methotrexate, sulfasalazine, and hydroxychloroquine with bridging glucocorticoid or treatment with methotrexate and glucocorticoid. Following 2 years, the percentage of patients who achieved sustained remission at 2 consecutive time points was 51% in patients on triple DMARD therapy compared with 47% of patients on monotherapy.

The prevalence of symptom flare ups after tapering medication was similar among both treatment groups.

“With significant numbers of patients achieving drug-free remission using less expensive biologicals during the first two years of therapy, these data should alleviate concerns regarding the need for long-term aggressive therapy," Dr. Weel said.