Combined Therapy for Rheumatoid Arthritis May Help Speed Remission

August 24, 2019

Combining methotrexate with a tumour necrosis factor (TNF) biologic or non-TNF biologics reduce disease activity and improves remission when compared with methotrexate alone, according to a study published in the Journal of General Internal Medicine.

For the study, Katrina E. Donahue, MD, University of North Carolina, Chapel Hill, North Carolina, and colleagues conducted a literature review of 22 articles published from 2012 to 2017, comprising 9,934 patients.

Results showed that more patients achieved an American College of Rheumatology (ACR) 50 response (50% improvement) if they were treated with a biologic plus methotrexate compared with methotrexate alone.

Combination therapy improved disease control, remission, and functional capacity compared with methotrexate monotherapy or biologic monotherapy.

Discontinuation rates due to adverse events or serious adverse events were similar between groups.

“The 2015 ACR guidelines conditionally recommend DMARD [disease-modifying antirheumatic drugs] monotherapy first in patients with moderate to severe early disease and strongly recommends it for mild disease,” said Katrina Donahue, MD, University of North Carolina, Chapel Hill, North Carolina. “Right now, biologics are generally prescribed after DMARD failure.However, our systematic review of the research suggests that combined therapy may actually provide patients a greater shot at remission without any additional side effects.”

“Our study lends support to the use of early combination therapy in patients with moderate to severe disease who do not have an early or robust response to DMARD monotherapy,” added Beth Jonas, MD, University of North Carolina School of Medicine. “In some cases, such as in patients with the most aggressive disease, initial treatment with a combination of MTX and a biologic might be considered.”

The authors noted some limitations to their study. Because the trials included in their analysis enrolled mostly patients with very high disease activity, the data may be less meaningful to patients with milder cases of RA. Available data also did not allow conclusions to be drawn for other patient subgroups based on demographics, serious comorbid conditions, or prior therapy.

“In future studies, researchers will need to include patients at different stages of disease activity,” said Dr. Donahue. “We also need more studies with longer treatment periods and follow-ups. Those data would help us understand how starting with a biologic improves long-term prognosis of RA.”

Reference: https://link.springer.com/article/10.1007/s11606-019-05230-0

SOURCE: University of North Carolina