Additional DMARD May Be Helpful in Refractory Arthritis

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Additional DMARD May Be Helpful in Refractory Arthritis

Ann Rheum Dis 2005;64:44-51.

http://www.medscape.com/viewarticle/496792?src=mp

Rather than switching disease modifying antirheumatic drugs (DMARDs) in

rheumatoid arthritis (RA) patients who are failing treatment, adding

another agent may be more advantageous, researchers in Paris report in

the January issue of the ls of the Rheumatic Diseases.

As senior investigator Dr. Maxime Dougados told Reuters Health, " this

study tried to answer a very pragmatic question when monitoring RA

patients. In a patient with still active disease despite the intake of a

DMARD, should I stop the current DMARD and switch to a new one, or

should I add a new DMARD to the current one? "

Dr. Dougados of Hopital Cochin and colleagues " took as an example,

leflunomide as the current non-sufficiently active DMARD and

sulfasalazine as the new DMARD. "

In particular, 106 inadequate responders to leflunomide were randomized

to switch to sulfasalazine plus placebo or sulfasalazine and leflunomide.

After 24 weeks, more patients in the combination group (30%) achieved an

improved response on the 28 joint count Disease Activity Score (DAS28)

than did patients who received sulfasalazine and placebo (20%). However,

these differences did not reach statistical significance.

Comparable numbers in each group showed an American College of

Rheumatology (ACR) 20% improvement. However, 8.9% of patients in the

combination group achieved an ACR 50% response. None in the

sulfasalazine and placebo group did so.

" Thus, despite the small sample size...this study suggests that the

additive strategy is better than the switching one, " Dr. Dougados

concluded. " In the future, more studies will be designed to answer a

question concerning the therapeutic strategy rather than limiting the

objectives to answer the question of the efficacy of a specific treatment. "