RESEARCH- MTX + SSZ more effective in RA patients who failed SSZ than in patients naive to both drugs

[Guest guest]

Rheumatology Advance Access originally published online on May 20, 2009

Rheumatology 2009 48(7):828-833; doi:10.1093/rheumatology/kep090

Methotrexate in combination with sulfasalazine is more effective in

rheumatoid arthritis patients who failed sulfasalazine than in

patients naïve to both drugs

Lydia G. Schipper1, Jaap Fransen1, Pilar Barrera1 and Piet L. C. M. Van Riel1

1Department of Rheumatology, Radboud University Nijmegen Medical

Centre, Nijmegen, The Netherlands.

Abstract

Objectives. For pharmacological reasons, the effect of the combination

of MTX and SSZ may be different in RA patients who are naïve to these

drugs compared to patients with an insufficient response to one of

them. Therefore, we compared the results of randomized controlled

trials (RCTs) on the combination of MTX and SSZ in naïve patients and

in patients with an insufficient response to SSZ.

Methods. A systematic literature search was performed to identify RCTs

that compared the MTX–SSZ combination to either drug alone. The

databases MEDLINE and the Cochrane Clinical Trials registry were

searched from 1966 up to April 2007. The efficacy of the single

therapeutic agents or their combination was assessed using the mean

change in the disease activity score (DAS) and the ACR improvement

criteria.

Results. Four RCTs were identified to compare the efficacy of the

combination MTX–SSZ to the efficacy of either drug alone. Two parallel

trials were performed with patients naïve to both drugs and two add-on

trials were performed in SSZ failures. In the trials with naïve

patients, the mean DAS changes for the combination MTX and SSZ pointed

to a sub-additive efficacy. In the trials with patients who previously

failed to SSZ, the mean DAS changes for the combination MTX and SSZ

indicated additive efficacy.

Conclusions. In RA, addition of MTX to SSZ is a therapeutic option in

SSZ failures, whereas combination of MTX and SSZ in DMARD-naïve

patients has no added value.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/7/828?etoc

Not an MD