Waddie and others, A follow up to Combo Therapy | Arthritis Information

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I just read this today and it fits right in with the article

http://www.rheumatologynews.com/article/S1541-9800(07)70129-1/fulltext I posted this morning.

Half of Early RA Patients Treated With Combo DMARDs Have No Disability After 11 Years
 
TAMPERE, Finland—Eleven-year follow-up data show that starting treatment of early rheumatoid arthritis (RA) with a combination of 3 DMARDs produces better long-term results than starting with a single DMARD, even if patients in the monotherapy group switch to combination DMARDs after year 2 of treatment. According to Vappu Rantalaiho, MD, and colleagues from the Finnish Rheumatoid Arthritis Combination Therapy (FIN-RACo) Trial, the key is to have remission as the goal and to adjust therapy to maintain tight clinical controls, including use of intraarticular glucocorticoid injections. The data are reported in Arthritis & Rheumatism.1

3 conventional DMARDS seen as effective—and cheap
”It is difficult to see why rheumatologists and RA patients should settle for single-DMARD therapy, when by starting with a combination of DMARDs, superior results are achieved without an increase in the number of adverse events. The combination of methotrexate, sulfasalazine, and hydroxychloroquine along with low-dose prednisolone, however, is not the ultimate, perfect treatment of early RA, since it does not cure the disease or produce sustained remission in all patients. Still, in real life, this combination is satisfactory for most patients and, even more importantly, is economically available for a large number of patients worldwide,” Dr. Rantalaiho said.

The researchers' economic considerations reflect widespread concern over the cost of and restriction of access to more expensive biologicals such as the TNF-α inhibitors in some countries with national health plans.

RA remission is the goal

The FIN-RACo study is the first published controlled trial using RA remission as the primary outcome target. The researchers randomized a cohort of 199 patients with early active RA to treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone, or to treatment with a single DMARD with or without prednisolone. The researchers began with sulfasalazine for the single-DMARD arm, but switched to methotrexate as that drug came into wider use. After two years of treatment according to initial assignment, the treatment strategy became unrestricted, with remission remaining as the treatment goal.

Table 1. ACR Remission Rates After Combination vs. Single-DMARD Initial Treatment in Early RA*
Years after beginning treatment Combination DMARDS - ACR remission rates Single DMARD - ACR remission rates P
11 years 37.00% 19.00% 0.017
2, 5, and 11 years 13.00% 3.00% 0.006
1-2 of these time points 54.00% 37.00% 0.006
no time points 32.00% 60.00% 0.006
*Treatment regimen could be changed at physician's option after year 2.
Source: Adapted from Rantalaiho et al.1

The 11-year analysis included 68 patients in the combination-DMARD group and 70 in the single-DMARD group.

Mean HAQ scores improved significantly in both groups, probably reflecting the tight control, the researchers said.

“Targeting remission with tight clinical controls results in good functional and clinical outcomes in most RA patients,” the investigators concluded.

Almost two-thirds of patients in the combination-DMARD group achieved modified minimal Disease Activity (MDA), vs. 43% in the single-DMARD group.

ACR remission rates at 11 years were 37% in the combination-DMARD group and 19% in the single-DMARD group. [Table 1]

The investigators reported that in patients with clinically active early RA, initial treatment with a combination of traditional DMARDs produced better long-term clinical disease activity and remission than initial therapy with a single DMARD.

“Furthermore,” Dr. Rantalaiho wrote, “tight clinical control with adjustments in the active DMARDs and injections of intraarticular corticosteroids preserves function in most of these patients irrespective of the initial DMARD strategy....We emphasize that after 11 years of RA, half of our patients had no disability according to the HAQ score, a finding that is in notable contrast with previously described cohorts.”

Reference

1. Rantalaiho V, Korpela M, Hannonen P, et al. The good initial response to therapy with a combination of traditional disease-modifying antirheumatic drugs is sustained over time. The eleven-year results of the Finnish Rheumatoid Arthritis combination Therapy Trial. Arthritis Rheum. 2009;60:1222-1231.

http://www.mskreport.com/articles.cfm?articleID=3338
 
edited to add an I
Lynn492009-05-07 16:14:22Lynn, what a great find!  Just the information I was looking for, you are a wonder!  This is another path to consider in the hunt.  Thank-you so much!   [QUOTE=waddie]Lynn, what a great find!  Just the information I was looking for, you are a wonder!  This is another path to consider in the hunt.  Thank-you so much!   [/QUOTE]
 
When I read this earlier today, I immediately thought of you Bumping for those who might have missed it!Dont Drs normally prescribe the right treatments...and this is a serious question..If I wanted to get a combination of meds right for me Id go see my rheumy and if I wasnt satisfied I'd ask for a second opinon from him or another Dr. it makes more sense than researching the internet...It worries me that so many people take medical advice from this site when no one is actually qualified to give it[QUOTE=Mrs Pincushion]Dont Drs normally prescribe the right treatments...and this is a serious question..If I wanted to get a combination of meds right for me Id go see my rheumy and if I wasnt satisfied I'd ask for a second opinon from him or another Dr. it makes more sense than researching the internet...It worries me that so many people take medical advice from this site when no one is actually qualified to give it[/QUOTE]
 
The purpose of these articles( which are, for the most part from Rheumatology journals) are to give people with RA information that can help them and their RD find the right combo of meds to treat their RA.
 
Most people who pm me tell me that they often print these articles off and take  them to their RD appointments.  I know I've done the same thing and my RD appreciates my interest in my condition/treatments.........
 
People post anecdotal evidence here all the time claiming that that info is a basis for people using a certain med.  As I've said numerous times .....
 
I don't recommend that anyone use any med without speaking to their doctors and doing research concerning the med.  I certainly don't expect them to use my posts or anyone else's anecdotal experiences as a basis to use a med.    
 
RA is different in everyone.  It's not a one size fits all disease.  There is a huge difference in believing something and actually knowing something.   In my opinion, posters need to keep that in mind when reading about the various meds used to treat, not cure, because there is no cure, RA.....................
Lynn492009-05-08 08:56:03Thanks Lynn, another weapon in the arsenal of being a full participant in my own health care. While I certainly trust and depend on my physicians, I want to versed in the available options and knowledgable about those options. Thanks, Lynn....a very good article and one that should be discussed with one's RD if it applies.  The wonderful thing about the internet is we have tens of thousands of pieces of research from reputable sites that can be used to keep us informed.  This information can also be used in CONJUNCTION with our RDs to develop a treatment plan.  
 
From my own experience RDs respect and work with a patient who is well informed and being well informed is looking at all of the information and research from reputable sites.  I'm not very fond of blog information but I do read all the research that's current and I also review older research to see if it's still viable.   
 
To all the newbies:  arm yourself with information and work with your RDs.  Ask questions and be armed with current and reputable research and facts to back you up.  Lindy
[QUOTE=Mrs Pincushion]Dont Drs normally prescribe the right treatments...and this is a serious question..If I wanted to get a combination of meds right for me Id go see my rheumy and if I wasnt satisfied I'd ask for a second opinon from him or another Dr. it makes more sense than researching the internet...It worries me that so many people take medical advice from this site when no one is actually qualified to give it[/QUOTE]

Pin, you are correct, Drs normally prescribe the right treatments.  However, I want to be able to discuss, intelligently, various treatments and treatment options with my RD rather than stumbling blindly into a treatment I don't know anything about.  I want to know the risk vs. the benefit.  I have the ultimate say so over what goes into my body so I choose to be informed. 

I have never taken medical advice from anyone on this forum and I wouldn't advise anyone do so.  I have listened to suggestions, done research, then discussed with my RD on everything, including supplements, before taking any medication, treatment or supplement.

 

Even before I had RA, I was proactive with my health and the health of my family.  I wouldn't take medical advice from someone off the internet any more than I would from some stranger off the street.
[QUOTE=waddie] [QUOTE=Mrs Pincushion]Dont Drs normally prescribe the right treatments...and this is a serious question..If I wanted to get a combination of meds right for me Id go see my rheumy and if I wasnt satisfied I'd ask for a second opinon from him or another Dr. it makes more sense than researching the internet...It worries me that so many people take medical advice from this site when no one is actually qualified to give it[/QUOTE]

Pin, you are correct, Drs normally prescribe the right treatments.  However, I want to be able to discuss, intelligently, various treatments and treatment options with my RD rather than stumbling blindly into a treatment I don't know anything about.  I want to know the risk vs. the benefit.  I have the ultimate say so over what goes into my body so I choose to be informed. 

I have never taken medical advice from anyone on this forum and I wouldn't advise anyone do so.  I have listened to suggestions, done research, then discussed with my RD on everything, including supplements, before taking any medication, treatment or supplement.

 

Even before I had RA, I was proactive with my health and the health of my family.  I wouldn't take medical advice from someone off the internet any more than I would from some stranger off the street.
[/QUOTE]
 
 
I think being proactive concerning your health and acquiring knowledge about your condition is very important.  I want to be an active partner in my treatment, not just a bystander............
Yep!  Me too!  Keep posting, Lynn.  I will be reading!   I have no intention of stopping now
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