Study: Two Disease Modifying Drugs Not Better Than One for Rheumatoid Arthritis

Two disease modifying antirheumatic drugs are not necessarily better than one when it comes to the early treatment of rheumatoid arthritis, according to a study reported in the August issue of the Annals of Rheumatic Diseases.

Enthusiasm among clinicians for using combinations of these disease modifying drugs has grown in recent years despite their high cost and significant side effects.

However, a team of French researchers found that patients receiving the combination therapy of methotrexate and sulfasalazine did not do better than those receiving just one of the drugs.

The results are surprising, according to researchers, because previous studies have suggested that some combinations of these drugs have a better effect on rheumatoid arthritis disease activity, functional status and structural changes than use of one drug alone.

The five-year study involved 146 patients suffering from rheumatoid arthritis for less than a year who were treated with either methotrexate or sulfasalazine or a combination of both. Patients were followed up and treated by their own rheumatologists, who were allowed to choose any treatment.

At the end of five years, the patients receiving single or combined treatment had similar disease activity, functional status and structural changes according to the researchers.

Researcher Maxime Dougados of the Institute of Rheumatology at Cochin Hospital in Paris told Medical Week that combination therapy is becoming more frequent since the objective now is no longer just to improve the condition of patients, but to also improve, prevent and even cure the deformities related to rheumatoid arthritis.

"The most important message is that a DMARD (disease-modifying antirheumatic drug) has to be initiated as soon as possible in the course of the disease and that the inflammatory process should be controlled as soon as possible by using mono- or combination-therapy," said Dougados.

Annals of the Rheumatic Disease 2003 Aug;62:8:764-766