For Early RA, Start with Six Months of MTX | Arthritis Information
For Early RA, Start with Six Months of MTX, then Add Two More DMARDs
PHILADELPHIA, Pennsylvania—Early rheumatoid arthritis (RA) responds as well to initial methotrexate (MTX) plus 2 more conventional DMARDs if needed after 6 months to bring disease under control as to MTX plus a more expensive anti-TNF inhibitor, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, PA.
”Patients initially receiving immediate MTX + etanercept or immediate triple-DMARDs were significantly more likely to achieve an ACR 20/50/70 response at 6 months than those randomized to step-up arms.”—Larry W. Moreland, MD
Larry W. Moreland, MD, Chief of the University of Pittsburgh's Rheumatology & Clinical Immunology Center, and a team of other top researchers set out to answer a question not previously addressed in a head-to-head trial: how would triple DMARD (methotrexate [MTX], sulfasalazine, hydroxychloroquine) therapy compare to MTX plus anti-TNF therapy (etanercept) for treatment of early RA?
They set up the TEAR investigator-initiated, multi-center, randomized trial to answer this question, and also to determine the relative benefit of a strategy of either combination versus MTX monotherapy with step-up after 6 months.
The researchers found that at 6 months, either combination therapy approach led to better responses than initial treatment with methotrexate alone. However, during the second year of this trial, they found no differences in the average levels of DAS28 between patients randomized to etanercept or triple DMARD therapy, regardless of whether they received immediate combination treatment or initial therapy with methotrexate with a step-up.
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