Methotrexate monotherapy plus a tumour necrosis factor (TNF) antagonist such as infliximab is the best treatment for early rheumatoid arthritis (RA), according to trials.
Antagonists like infliximab and conventional disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and hydroxychloroquine are better than methotrexate alone, according to a report in The Lancet.
Tests by Ronald van Vollenhoven and colleagues at the Karolinska University Hospital and Karolinska Institute in Sweden involved 487 patients with early RA of less than 1 year’s duration.
After three to four months treatment with methotrexate alone, patients also receive either infliximab or sulfasalazine and hydroxychloroquine.
After 12 months, 25% of patients given sulfasalazine and hydroxychloroquine and 39% of patients given infliximab achieved a good response, as judged by European League Against Rheumatism (EULAR) scores.
The authors conclude: “We believe that by treating all patients with methotrexate for 3-4 months, we screened out a sizeable proportion (30% in this trial) who would have been overtreated if aggressive combination therapy was used for all, an approach that could have increased the risk of side-effects and potentially entailed high costs.”
Copyright Press Association 2009