Three Disease-Modifying Drugs Are Better Than Two For Rheumatoid Arthritis

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Three Disease-Modifying Drugs Are Better Than Two For Rheumatoid Arthritis

NEW YORK (Reuters Health) Jun 19 - The combination of three

disease-modifying antirheumatic drugs (DMARDs) is more effective against

rheumatoid arthritis than two-drug combinations, according to a report in

the May issue of Arthritis & Rheumatism.

Previous research demonstrated the effectiveness of DMARDs in the treatment

of rheumatoid arthritis, the authors explain, as well as the superiority of

the triple combination of methotrexate, sulfasalazine, and

hydroxychloroquine over methotrexate alone and over sulfasalazine plus

hydroxychloroquine.

Dr. R. O'Dell from University of Nebraska Medical Center in Omaha and

colleagues compared the triple-drug combination with the double combinations

of methotrexate -sulfasalazine and methotrexate-hydroxychloroquine in the

treatment of 171 rheumatoid arthritis patients who had not previously

received combination DMARD therapy.

Fourteen patients evenly distributed among the three treatment arms were

withdrawn from the trial by their physicians because of side effects

potentially related to the study medications, the report indicates.

Twenty percent improvement, according to American College of Rheumatology

criteria, was attained by 45 of the 58 patients in the triple-drug treatment

group, the authors report, compared with 35 of 58

methotrexate-hydroxychloroquine patients and 27 of 55

methotrexate-sulfasalazine patients, a difference that was statistically

significant (p = 0.007).

In patients without prior methotrexate exposure, triple-drug therapy was

only marginally superior to methotrexate-hydroxychloroquine treatment, the

researchers note, and for patients with an earlier suboptimum response to

methotrexate, triple-drug therapy was clearly superior to

methotrexate-sulfasalazine.

" The triple combination of methotrexate, sulfasalazine, and

hydroxychloroquine is well-tolerated and relatively inexpensive, " the

authors conclude. " The superior efficacy of this combination over single or

double therapy has not been demonstrated in two trials of patients with

early rheumatoid arthritis and in two trials of patients with more

established rheumatoid arthritis. "

" Almost all RA patients should be started on DMARDs by the time they have 3

months of disease, unless all synovitis is gone with NSAIDs alone, " Dr.

O'Dell told Reuters Health.

" I start therapy with a single DMARD (usually methotrexate) and escalate the

dose rapidly to 25 mg, " explained Dr. O'Dell. " If necessary, prednisone at

(5 mg/day to 7.5 mg/day) is also often initiated at the very beginning. If

the patient is not in remission or really close, I add hydroxychloroquine

and sulfasalazine. "

Arthritis Rheum 2002:46:1164-1170.

Reuters Health Information 2002.

http://www.infotech.demon.co.uk/3drugs.htm