With newer treatments available, rheumatoid
arthritis patients now lead a more comfortable and pain-free life. Doctors usually start the treatment with a
drug called methotrexate, which belongs to the group Disease Modifying Anti-Rheumatic
. If the patient does not
respond to the medication, a biological agent is usually added. The other option is to add additional DMARDs
The newer biological therapies have transformed the
lives of many. These include therapies which belong to a group referred to as
the tumor necrosis factor (TNF)
However, biological treatment has a huge price tag attached to it, and
may not be economically feasible to a number of patients.
A study published in the New England Journal of Medicine
compared patient response to a
combination of conventional DMARDs and methotrexate, and the use of the
biological agent etanercept with methotrexate in patients who were already
taking methotrexate and yet suffered from active disease.
One group of patients received three drugs,
sulfasalazine and hydroxychloroquine and methotrexate; this group is referred
to as the triple therapy group. The
second group received weekly etanercept injections with methotrexate. Patients
who did not respond to one therapy were shifted to the other after 24 weeks of
treatment. In addition, the
participants could also take their nonsteroidal anti-inflammatory drugs
(NSAIDs) and prednisone when needed.
Statistical analyses of the results available from
309 patients who completed the study indicate that treatment with the triple
therapy is not inferior to the etanercept-methotrexate therapy. There were no significant radiological
changes between the two groups at the end of 48 weeks. Both the groups had a
similar number of patients that switched treatment by 24 weeks. People who switched the treatment to the
alternative treatment showed improvement at the end of 48 weeks.
Though patients on etanercept-methotrexate therapy
showed better results at 24 weeks of treatment, the results were similar at the
end of 48 weeks. This may indicate a faster response to the
etanercept-methotrexate therapy in some cases.
The frequency of adverse events due to the
treatments was similar in both groups. While digestive tract disorders were
more frequent in patients on the triple therapy, infections and disorders of
the skin and subcutaneous tissue were more common with the
etanercept-methotrexate therapy. The
number of serious adverse events was more common in the etanercept-methotrexate
researchers suggest that rheumatoid arthritis patients who do not respond to
methotrexate should be first switched to a combination of DMARDs like the
triple therapy used in this study
Those who do not respond to this treatment can move over to a
combination like etanercept-methotrexate.
This approach could reduce the cost of treatment for quite a few
patients without compromising on the clinical outcome of the disease.
Therapies for Active Rheumatoid Arthritis after Methotrexate Failure;
James Dell et al; NEJM 2013