In a nutshell
This study examined the outcomes of reducing the dosage of methotrexate (Rheumatrex) when it is combined with adalimumab (Humira) in the treatment of rheumatoid arthritis (RA). The study found that a higher dose of methotrexate lead to a greater decrease in disease activity. Reduction of methotrexate dosage is not supported by these findings.
Some background
Patients with RA often experience inflammation of the membranes in their joints (known as synovitis), bone damage and reduced physical function. If the condition is moderate to severe, patients will usually receive a treatment such as methotrexate to reduce inflammation and destruction of joints. Some patients do not respond to methotrexate alone, and will need additional treatment.
The combination of methotrexate and adalimumab is a common treatment for RA, as it is proven to lower disease activity. However, the optimum dose of each is not yet known.
Methods & findings
This 24-week trial included 309 patients who had previously received methotrexate treatment. Patients were randomly assigned to one of two treatment groups. One group of patients received a low dose of methotrexate (7.5 mg/week) in conjunction with adalimumab. A second group of patients received a high dose of methotrexate (20 mg/week) in conjunction with adalimumab.
Both groups showed a significant decrease in disease activity. However, the high dose group experienced a significantly greater improvement in disease activity compared to the low dose group.
More of the patients receiving the high dose showed RA remission (temporary end of disease activity) after the study than those receiving the low dose.
Similar rates of side effects were reported in both groups.
The bottom line
This study concluded that a higher dose of methotrexate in conjunction with adalimumab is more effective at reducing the disease activity score and the dosage should not be lowered.
The fine print
Disease activity was still decreasing at the end of the study. A longer study duration may be useful.
Published By :
The Journal of Rheumatology
Date :
Jun 15, 2016
