Rational use of new and existing disease-modifying agents in rheumatoid arthritis

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Methotrexate monotherapy is insufficient for many rheumatoid arthritis (RA) patients, evidenced by progressive bone loss and persistent synovial proliferation.
• Established disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine and hydroxychloroquine show efficacy when combined with methotrexate.
• Newer DMARDs, including leflunomide, etanercept, and infliximab, have emerged with demonstrated efficacy in randomized controlled studies.

Purpose of the Study:

• To evaluate the efficacy of combining methotrexate with new and existing disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis (RA) treatment.
• To assess the impact of combination DMARD therapy on radiographic progression and clinical response in RA patients.
• To analyze the safety profile and cost-effectiveness of advanced RA treatment strategies.

Main Methods:

• Review of randomized, controlled studies evaluating new DMARDs (leflunomide, etanercept, infliximab) and established DMARDs in combination with methotrexate.
• Analysis of clinical response, radiographic progression, and adverse events reported during 2-year treatment periods.
• Consideration of long-term safety, efficacy, and societal costs associated with combination DMARD therapy.

Main Results:

• Combination therapy involving methotrexate with new or existing DMARDs significantly improves clinical responses in rheumatoid arthritis (RA).
• These combination regimens effectively halt radiographic bone loss progression over a 2-year treatment period.
• While toxicity is a concern, few serious adverse events were reported in short-term studies; new agents are costly but may offset long-term healthcare expenses.

Conclusions:

• Combining methotrexate with newer or established DMARDs represents a significant advancement in rheumatoid arthritis (RA) therapy, enhancing clinical outcomes and preventing bone deterioration.
• The long-term safety, efficacy, and cost-effectiveness of these aggressive combination strategies require further investigation to establish their definitive value.
• Aggressive RA treatment, including combination DMARD therapy, may reduce the personal and societal burden of the disease, including joint replacement and disability.