RESEARCH - Combination therapy with sulfasalazine and MTX more effective than either alone in RA

[Guest guest]

Ann Rheum Dis. 2006 Aug 22; [Epub ahead of print]

Combination therapy with sulphasalazine and methotrexate is more effective

than either drug alone in rheumatoid arthritis (ra) patients with a

suboptimal response to sulphasalazine: Results from the double blind placebo

controlled mascot study.

Capell H, Madhok R, Porter D, Munro R, McInnes I, Hunter J, M, Zoma

A, on E, Sambrook M, Poon FW, Hampson R, Mc F, Tierney A,

N, Ford I.

Centre for Rheumatic Diseases, United Kingdom.

BACKGROUND: Optimal use of disease modifying anti-rheumatic drugs (DMARDs)

in rheumatoid arthritis (RA) is vital if progression of disease is to be

reduced. Methotrexate (MTX) and sulphasalazine (SASP) are widely used

inexpensive DMARDs, recently often combined despite no firm evidence of

benefit from previous studies. Aims: To establish if a combination of

sulphasalazine and methotrexate is superior to either drug alone in RA

patients with a suboptimal response to six months of sulphasalazine.

METHODS: Randomized controlled study of step-up DMARD therapy in early RA.

Phase I: 687 patients received sulphasalazine for six months. Those with a

disease activity score (DAS) >2.4 were offered additional therapy in Phase

II (sulphasalazine alone, methotrexate alone or a combination of the two).

Primary outcome measure was change in DAS. RESULTS: At 6 months 191 patients

(28%) had a DAS <2.4, 123 (18%) were eligible but did not wish to enter

Phase II, 130 (19%) stopped SASP because of reversible adverse events and

165 (24%) entered Phase II. DAS at 18 months was significantly lower in

those who received combination compared with either sulphasalazine or

methotrexate: monotherapy arms did not differ. Improvement in EULAR and ACR

20, 50 and 70 scores favoured combination therapy.

CONCLUSIONS: In this inverted exclamation mark yentrue-to-life inverted

exclamation mark| study an inexpensive combination of DMARDs proved more

effective than monotherapy in RA patients with a suboptimal response to

sulphasalazine. There was no increase in toxicity. These results provide an

evidence base for the use of this combination as a component of tight

control strategies.

PMID: 16926184

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6926184

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

Hi ,

I am allergic to sulfa. So if I ever get RA, does that mean I can't

teke the sulphasalazine? Just curious.

Debbie L

>

> Ann Rheum Dis. 2006 Aug 22; [Epub ahead of print]

>

>

> Combination therapy with sulphasalazine and methotrexate is more

effective

> than either drug alone in rheumatoid arthritis (ra) patients with a

> suboptimal response to sulphasalazine: Results from the double

blind placebo

> controlled mascot study.

>

>

> Capell H, Madhok R, Porter D, Munro R, McInnes I, Hunter J,

M, Zoma

> A, on E, Sambrook M, Poon FW, Hampson R, Mc F, Tierney

A,

> N, Ford I.

>

> Centre for Rheumatic Diseases, United Kingdom.

>

> BACKGROUND: Optimal use of disease modifying anti-rheumatic drugs

(DMARDs)

> in rheumatoid arthritis (RA) is vital if progression of disease is

to be

> reduced. Methotrexate (MTX) and sulphasalazine (SASP) are widely

used

> inexpensive DMARDs, recently often combined despite no firm

evidence of

> benefit from previous studies. Aims: To establish if a combination

of

> sulphasalazine and methotrexate is superior to either drug alone

in RA

> patients with a suboptimal response to six months of

sulphasalazine.

> METHODS: Randomized controlled study of step-up DMARD therapy in

early RA.

> Phase I: 687 patients received sulphasalazine for six months.

Those with a

> disease activity score (DAS) >2.4 were offered additional therapy

in Phase

> II (sulphasalazine alone, methotrexate alone or a combination of

the two).

> Primary outcome measure was change in DAS. RESULTS: At 6 months

191 patients

> (28%) had a DAS <2.4, 123 (18%) were eligible but did not wish to

enter

> Phase II, 130 (19%) stopped SASP because of reversible adverse

events and

> 165 (24%) entered Phase II. DAS at 18 months was significantly

lower in

> those who received combination compared with either sulphasalazine

or

> methotrexate: monotherapy arms did not differ. Improvement in

EULAR and ACR

> 20, 50 and 70 scores favoured combination therapy.

>

> CONCLUSIONS: In this inverted exclamation mark yentrue-to-life

inverted

> exclamation mark| study an inexpensive combination of DMARDs

proved more

> effective than monotherapy in RA patients with a suboptimal

response to

> sulphasalazine. There was no increase in toxicity. These results

provide an

> evidence base for the use of this combination as a component of

tight

> control strategies.

>

> PMID: 16926184

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve & db=PubMed & list_uids=16926184

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

[Guest guest]

If you have had a true allergic reaction to a sulfonamide in the past, it

probably wouldn't be the best idea, Debbie, but your physician would make

that call.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - Combination therapy with sulfasalazine

and MTX more effective than either alone in RA

> Hi ,

> I am allergic to sulfa. So if I ever get RA, does that mean I can't

> teke the sulphasalazine? Just curious.

>

> Debbie L