In a nutshell
This study examined what drug treatment strategy is best for treating patients with early rheumatoid arthritis.
Some background
Treatment for patients with rheumatoid arthritis aims to achieve remission (a decrease in or disappearance of signs and symptoms of disease). In recent decades big improvements have been made in the treatment options available for patients. However, the best drug choice for patients with early rheumatoid arthritis and the rates of remission with different treatments are unclear.
Initial research suggests that methotrexate (Rheumatrex, Trexall; the most commonly used treatment for patients with rheumatoid arthritis) alone can slow the onset of symptoms but does not prevent joint damage. It has been suggested that treatment with prednisone (Deltasone; a steroid drug) along with methotrexate could improve the chance of patients achieving early remission.
Methods & findings
610 patients with early rheumatoid arthritis (479 patients) or undefined arthritis (122 patients) were included in the study. All patients were treated with methotrexate and prednisone. After 4 months patients were examined for signs of remission. 63% of patients were in remission and prednisone and methotrexate were gradually stopped. After 1 year 68% of patients were still in remission and 32% of patients were in drug-free remission (they did not have to take any medication for rheumatoid arthritis).
The 161 patients (26%) who were not in remission after 4 months were randomly divided into 2 different drug treatment groups. Group 1 (83 patients) received methotrexate, hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and prednisone. Group 2 (78 patients) received methotrexate and adalimumab (HUMIRA). After 8 months more patients in group 2 were in remission (41%) than in group 1 (25%).
Over the 1 year of treatment 16% of patients never achieved remission.
The number of adverse events were common for all treatments. 53% of patients who achieved early remission, 74% of patients in group 1 and 68% of patients in group 2 had adverse events. Similar adverse events were reported for all groups: infections, skin symptoms and stomach problems. Patients in group 1 also reported higher levels of dizziness, headaches and mood changes than patients in other groups.
The bottom line
The authors concluded that most patients with early rheumatoid arthritis can achieve remission with this treatment approach. They also suggest that methotrexate plus adalimumab is more successful than multiple drugs if remission was not achieved initially.
The fine print
This study was financially supported by Abbott who market adalimumab.
Published By :
Annals of the rheumatic diseases
Date :
Jul 01, 2014
