Optimising Conventional Therapy in Rheumatoid Arthritis.

Area of Science:

• Rheumatology
• Clinical Pharmacology
• Immunology

Background:

• Rheumatoid arthritis (RA) management historically faced challenges achieving remission before biologic therapies.
• Limited therapeutic options in the 1980s-1990s, primarily conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and steroids, resulted in many patients not reaching low disease activity (LDA).
• Despite advancements with biologic (b) and targeted synthetic (ts) DMARDs, unmet needs in RA treatment persist.

Purpose of the Study:

• To evaluate the efficacy and safety of csDMARDs within treat-to-target (T2T) and tight control strategies for RA.
• To highlight the potential of conventional therapies in early RA management.
• To underscore the cost-effectiveness of csDMARDs compared to newer biologic therapies.

Main Methods:

• Review of clinical trials confirming the efficacy and safety of csDMARDs.
• Analysis of treatment strategies involving methotrexate (MTX) in combination with other csDMARDs, with or without steroids.
• Assessment of MTX's cardioprotective effects and cardiovascular risk reduction in RA patients.

Main Results:

• csDMARDs, especially methotrexate, demonstrate efficacy and safety in RA management when used with T2T and tight control.
• Methotrexate combination therapy is less expensive than biologic therapies.
• Methotrexate has shown cardioprotective effects, reducing cardiovascular event risk in RA patients.

Conclusions:

• Optimal and early utilization of csDMARDs can achieve disease control comparable to biologic therapies at a lower cost.
• Conventional therapies, particularly methotrexate, represent a viable and potentially improvable strategy for early RA management.
• The T2T approach combined with csDMARDs offers a promising strategy for achieving LDA and remission in RA.