RESEARCH - MTX therapy in RA after sulfasalazine failure: to switch or to add?

[Guest guest]

Rheumatology Advance Access published online on July 28, 2009

Rheumatology, doi:10.1093/rheumatology/kep158

Methotrexate therapy in rheumatoid arthritis after failure to

sulphasalazine: to switch or to add?

Lydia G. Schipper1, Jaap Fransen1, Pilar Barrera1, Alfons A. den

Broeder2 and Piet L. C. M. Van Riel1

1Department of Rheumatology, Radboud University Nijmegen Medical

Centre and 2Department of Rheumatology, Sint Maartenskliniek Nijmegen,

Nijmegen, The Netherlands.

Abstract

Objectives. MTX, either alone or in combination with SSZ, is effective

in the treatment of RA. Trials have shown that, after SSZ failure, the

addition of MTX to SSZ is more effective than a switch to MTX. Whether

this is also the case in daily practice has not been analysed yet. In

this study, we compared the efficacy of a switch to MTX monotherapy

with that of the addition of MTX to SSZ in the daily clinical practice

of RA patients who had failed SSZ monotherapy in the Nijmegen RA

Inception Cohort.

Methods. For this study, 230 patients who failed to SSZ monotherapy

were followed for up to 52 weeks. A total of 124 underwent a switch to

MTX alone, whereas 106 patients received the combination of MTX and

SSZ. The primary outcome measure was the mean change in the disease

activity score (DAS28) after 24 weeks.

Results. Both treatment groups showed a significant decrease in DAS28

after 24 weeks, which was similar in both groups. Drug survival

analysis showed that the chance to stop with a DMARD within 52 weeks

was higher in the MTX–SSZ group (P <0.01).

Conclusions. In RA patients who failed to SSZ the clinical efficacy of

a switch to MTX monotherapy was similar to that of the addition of

MTX, suggesting that in daily clinical practice a switch to MTX is a

good option for patients with an inadequate response to SSZ.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep158v1?papetoc

Not an MD

[Guest guest]

Thanks again, . This was very interesting to me. I've been taking the SSZ

and MTX combo for a long time - with some success. Yesterday, my Rheumy FINALLY

agreed to let me do the antibiotic protocol. Now I've added 100mg Minocycline

twice daily to the SSZ/MTX combo. He warned me that it could affect my liver, so

I also added 1 cap twice daily of Milk Thistle just to hopefully keep my liver

healthy.

I pray this new combo will be the right one. He initially wanted me to give the

Enbrel a second try, but after getting that sinus/ear infection within 7 weeks

of trying the Enbrel, I am a little fearful of trying it again. We came to a

compromise that if the Minocycline didn't work for me, I would then try the

Enbrel again.

I so appreciate all the research you do for us, . Praying for pain free days

ahead for all.....Doreen

>

> Rheumatology Advance Access published online on July 28, 2009

> Rheumatology, doi:10.1093/rheumatology/kep158

>

> Methotrexate therapy in rheumatoid arthritis after failure to

> sulphasalazine: to switch or to add?

>

> Lydia G. Schipper1, Jaap Fransen1, Pilar Barrera1, Alfons A. den

> Broeder2 and Piet L. C. M. Van Riel1

> 1Department of Rheumatology, Radboud University Nijmegen Medical

> Centre and 2Department of Rheumatology, Sint Maartenskliniek

> Nijmegen, Nijmegen, The Netherlands.

>

> Abstract

>

> Objectives. MTX, either alone or in combination with SSZ, is

> effective in the treatment of RA. Trials have shown that, after SSZ

> failure, the addition of MTX to SSZ is more effective than a switch

> to MTX. Whether this is also the case in daily practice has not

> been analysed yet. In this study, we compared the efficacy of a

> switch to MTX monotherapy with that of the addition of MTX to SSZ

> in the daily clinical practice of RA patients who had failed SSZ

> monotherapy in the Nijmegen RA Inception Cohort.

>

> Methods. For this study, 230 patients who failed to SSZ monotherapy

> were followed for up to 52 weeks. A total of 124 underwent a switch

> to MTX alone, whereas 106 patients received the combination of MTX

> and SSZ. The primary outcome measure was the mean change in the

> disease activity score (DAS28) after 24 weeks.

>

> Results. Both treatment groups showed a significant decrease in

> DAS28 after 24 weeks, which was similar in both groups. Drug

> survival analysis showed that the chance to stop with a DMARD

> within 52 weeks was higher in the MTX–SSZ group (P <0.01).

>

> Conclusions. In RA patients who failed to SSZ the clinical efficacy

> of a switch to MTX monotherapy was similar to that of the addition

> of MTX, suggesting that in daily clinical practice a switch to MTX

> is a good option for patients with an inadequate response to SSZ.

>

> http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep158v1?papetoc

>

>

>

> Not an MD

[Guest guest]

You're so welcome, Doreen.

I hope the minocycline helps you!

Not an MD

On Fri, Aug 7, 2009 at 6:36 AM, Mimi<mimi212@...> wrote:

> Thanks again, . This was very interesting to me. I've been taking the SSZ

and MTX combo for a long time - with some success. Yesterday, my Rheumy FINALLY

agreed to let me do the antibiotic protocol. Now I've added 100mg Minocycline

twice daily to the SSZ/MTX combo. He warned me that it could affect my liver, so

I also added 1 cap twice daily of Milk Thistle just to hopefully keep my liver

healthy.

>

> I pray this new combo will be the right one. He initially wanted me to give

the Enbrel a second try, but after getting that sinus/ear infection within 7

weeks of trying the Enbrel, I am a little fearful of trying it again. We came to

a compromise that if the Minocycline didn't work for me, I would then try the

Enbrel again.

>

> I so appreciate all the research you do for us, . Praying for pain free

days ahead for all.....Doreen