Another study about the benefits of treating new rheumatoid arthritis patients with combination drug therapy was published this March in the Annals of Internal Medicine online. There were four treatment groups: 1) a single DMARD group; 2) a step-up to a combination of three DMARDS; 3) methotrexate, sulfasalazine and high-dose prednisone; or 4) methotrexate plus infliximab. While all groups showed improvement in the first year and maintained that improvement in the second year, the two groups that received combination therapy improved more quickly and had less joint damage.
The interesting factor in this study, is that it wasn’t a blind study. Physicians knew what group each patient was in. It was like normal clinical practice in that physicians had the flexibility to change drugs or increase dosages and drugs to produce the best results for each patient. They also measured successful treatment by an overall disease activity score instead of a percentage of improvement above baseline. The researchers concluded overall that the current antirheumatic drugs are very effective in early arthritis if patients are managed closely by their physicians. Second, beginning treatment more aggressively with combination therapy seems to provide earlier clinical improvement and less progression of joint damage. Finally, combination therapy requires fewer treatment adjustments and can be scaled back successfully when improvement is shown possible avoiding joint damage better than beginning with one drug.
A corresponding editorial written by Dr. James O’Dell in the online journal summarized the study well. He states that all RA patients should have close contact between themselves, their primary care physician and the rheumatologist. Second, he believes that all patients should receive at least one DMARD, usually methotrexate, as soon as possible. Rheumatologists should adjust dosages or drugs in a timely fashion, whatever that means for each patient. He writes that the next challenge for physicians and researchers will be to pinpoint early which treatments, either single drugs or which combinations, will benefit each patient individually to save time, money, and the patient’s quality of life.
The interesting factor in this study, is that it wasn’t a blind study. Physicians knew what group each patient was in. It was like normal clinical practice in that physicians had the flexibility to change drugs or increase dosages and drugs to produce the best results for each patient. They also measured successful treatment by an overall disease activity score instead of a percentage of improvement above baseline. The researchers concluded overall that the current antirheumatic drugs are very effective in early arthritis if patients are managed closely by their physicians. Second, beginning treatment more aggressively with combination therapy seems to provide earlier clinical improvement and less progression of joint damage. Finally, combination therapy requires fewer treatment adjustments and can be scaled back successfully when improvement is shown possible avoiding joint damage better than beginning with one drug.
A corresponding editorial written by Dr. James O’Dell in the online journal summarized the study well. He states that all RA patients should have close contact between themselves, their primary care physician and the rheumatologist. Second, he believes that all patients should receive at least one DMARD, usually methotrexate, as soon as possible. Rheumatologists should adjust dosages or drugs in a timely fashion, whatever that means for each patient. He writes that the next challenge for physicians and researchers will be to pinpoint early which treatments, either single drugs or which combinations, will benefit each patient individually to save time, money, and the patient’s quality of life.
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The Case for Writing Things Down
