Drug Combos Effective Against Rheumatoid Arthritis

Drug Combos Effective Against Rheumatoid Arthritis
MONDAY, Nov. 26 (HealthDay News) -- Combining an older syntheticdrug with a newer, "biologic" medication may work best to ease the jointswelling and tenderness of rheumatoid arthritis, a new study finds.
There are many therapies for rheumatoid arthritis, but the newer drugsare not better than older ones when used alone, the report's authorsfound.
"There are no clinically important differences among the oldersynthetic drugs or among the newer biologic drugs," said lead researcherDr. Katrina E. Donahue, an assistant professor in the department of familymedicine at the University of North Carolina, Chapel Hill. "There arecombination therapies that do work better than using one drug in peoplenot responding to one drug alone," she said.
Combining a synthetic with a biologic appears to work best, Donahuesaid. However, which combinations are most effective still isn't clear. Inaddition, the short-term side effects appear to be the same for both typesof drugs, she added.
In the study, Donahue's team reviewed 23 published studies thatcompared the benefits and harms of different rheumatoid arthritis drugs.These included, synthetic disease-modifying antirheumatic drugs (DMARDs),biologic DMARDs, and corticosteroids.
Synthetic DMARDs include hydroxychloroquine (Plaquenil), leflunomide(Arava), methotrexate (Trexall) and sulfasalazine (Azulfidine). BiologicDMARDs include abatacept (Orencia), adalimumab (Humira), anakinra(Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab(Rituxan). Corticosteroids include drugs such as prednisone.
Donahue's group found that combining methotrexate with a biologic DMARDworked better than methotrexate or a biologic alone. They also found thatmethotrexate was as effective as the biologics adalimumab and etanerceptin early rheumatoid arthritis.
Adalimumab and etanercept had better short-term results. However,biologics and methotrexate boost the risk of serious infection, includinga reoccurrence of tuberculosis, the researchers found.
Donahue's team also found that prednisone, along withhydroxychloroquine, methotrexate or sulfasalazine worked better inreducing joint swelling and tenderness than using a synthetic DMARDalone.
There was no difference in effectiveness between the synthetic DMARDsmethotrexate, leflunomide and sulfasalazine. And combining methotrexateand sulfasalazine was no more effective than using either one of the drugsalone.
There was also not enough evidence to say whether combining twobiologics was more effective than using one biologic, Donahue said. Forevery 1,000 people taking a biologic for three to 12 months, 17 have aserious infection and combining two biologics can increase that risk, theresearchers noted.
In addition, rates of painful injection site reactions are more commonfor anakinra (67 percent) than for etanercept (22 percent) or adalimumab(18 percent), Donahue's group found.
Donahue recommended that patients talk to their doctors aboutdeveloping a treatment plan that is tailored to their individualcondition. "Rheumatoid arthritis is very patient-specific -- there aremany therapies, and there doesn't appear to be one therapy that is clearlysuperior," she said. "It's a conversation between you and yourrheumatologist about what might be right for you."
One expert said the study will be useful for physicians.
"This is a great summary about what we know about how DMARDs work,"said Dr. Steven Vlad, a fellow in rheumatology at Boston UniversityMedical Center. "That basic finding -- that one synthetic of biologicdoesn't work any better than others -- is a good thing to remind ourselvesof," he said.
Some doctors think that biologics work better, Vlad said. "But that'snot the case. All these drugs seem to work equally as well," he said.
Combination therapy can be effective, Vlad said, but biologics shouldbe the last choice. "Methotrexate is what most doctors are going to gowith first," he said. "You start with methotrexate. If that doesn't work,you add another synthetic drug; if that doesn't work, maybe then you go toa biologic," he said.
More information
For more on rheumatoid arthritis, visit the Arthritis Foundation.