Combined Meds, Often Best Therapy Against Rheumatoid Arthritis

According to a new report by researchers at the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (sponsored by the Agency for Healthcare Research and Quality), combining one well-known, lower-cost synthetic drug with one of six biologic medications — often works best to reduce joint swelling or tenderness in rheumatoid arthritis patients.

Researchers reviewed published evidence to compare the benefits and harms of three classes of medications: synthetic disease-modifying antirheumatic drugs (DMARDS), biologic DMARDs, and corticosteroids.

Synthetic DMARDS include hydroxychloroquine, leflunomide, methotrexate, and sulfasalazine; biologic DMARDS include abatacept, adalimumab, anakinra, etanercept, infliximab, rituximab; and corticosteroids include drugs such as prednisone.

The report concluded that combining methotrexate, a synthetic DMARD, with one of the biologic DMARDs works better than using methotrexate or a biologic DMARD alone.

The report also found that methotrexate works as effectively as the biologic DMARDs adalimumab and etanercept for patients who have early rheumatoid arthritis.

Adalimumab and etanercept are more likely, however, to show better short-term results as measured by X-rays of joints. The report also emphasized that biologic DMARDs and methotrexate increase the risk of serious infection, including a reoccurrence of tuberculosis.

We already know that rheumatoid arthritis is an autoimmune disease affecting about 2 million Americans – of unknown cause that often begins with fatigue, morning stiffness, weakness, and muscle aches. And then eventually, joint pain appears (pain may affect the wrists, knees, elbows, fingers, toes, ankles or neck).

According to AHRQ Director Carolyn M. Clancy, M.D:

“Rheumatoid arthritis is a painful, degenerative disease that affects people of all ages and can profoundly impact quality of life. This report establishes a clear, unbiased summary of what is known about current treatments. It also identifies areas where more research is needed.”

The following are also additional important findings in the said report, according to Katrina Donahue, M.D., M.P.H. (assistant professor of family medicine in the UNC School of Medicine and a fellow in the Cecil G. Sheps Center for Health Services Research at UNC and is lead author of the report):

• Combining prednisone with the synthetic DMARD hydroxychloroquine, methotrexate or sulfasalazine works better than using only a synthetic DMARD to reduce joint swelling and tenderness and to improve function.
• No meaningful clinical differences can be found between methotrexate and either leflunomide or sulfasalazine.
• Combining the synthetic DMARDs methotrexate and sulfasalazine is no more effective than using just one of the medications for patients with early rheumatoid arthritis.
• Not enough evidence exists to determine whether combining two biologic DMARDs is more effective than using one biologic DMARD.
• About 17 of every 1,000 people taking a biologic DMARD for 3 to 12 months have a serious infection. Combining two biologic DMARDs can increase the risk.
• Among biologic DMARDS, rates of painful injection site reactions are more common for anakinra (67 percent) than for etanercept (22 percent) or adalimumab (18 percent).

Find more details from UNC at Chapel Hill.