Combination vs. monotherapy: which treatment strategy is effective in the long-term?

This study investigated if treatment with just biological drugs or a combination of biological and synthetic drugs is effective long-term in rheumatoid arthritis (RA).

They found that combination treatment is associated with a lower risk of treatment failure.

Treating rheumatoid arthritis (RA) involves taking medication to reduce inflammation. These medications are called anti-rheumatic disease-modifying drugs (DMARDs). DMARDs are classified as biological (b) or conventional synthetic (cs). Many patients respond well to a combination of bDMARDs and csDMARDs. To determine if a medication is working well the doctor will look at how it affects disease activity. Patients with RA may be treated with one drug (monotherapy) or multiple drugs (combination therapy).

Another measure of drug effectiveness is how long a patient stays on a drug regimen. This effect is called persistence. Measuring persistence can tell us if a treatment is effective and well tolerated. It may also predict if a certain drug(s) is/are more likely to be effective long-term. It is not clear if monotherapy or combination therapy is successful in RA.

This study included the records of 4478 patients with RA. The types of DMARDs and the length of treatment were analyzed. 

17.8% of patients were taking a bDMARD alone (bDMARD monotherapy). 82.2% of patients were taking a combination of a bDMARD and a csDMARD. Etanercept (ETA) was the most commonly prescribed bDMARD. Methotrexate was the most commonly prescribed csDMARD.

Patients taking a combination of bDMARDs and csDMARDs had a 21% lower risk of treatment failure. ETA had the lowest risk of treatment failure of all monotherapies

The authors concluded that combination treatment is associated with a lower risk of treatment failure.

This study investigated the length of time a patient was on a drug regimen. The success of treatment in this study was how long a patient persisted on the regimen. It did not analyze disease activity or joint damage.

If you have any questions regarding rheumatoid arthritis treatment, please consult with your doctor.