RA Treatment: Simpler is Better
Recent research shows that patients with rheumatoid arthritis (RA) are more likely to follow a simple drug therapy program, such as methotrexate (MTX) plus a tumor necrosis factor inhibitor (TNFi), than follow a “triple-therapy” regimen of MTX, hydroxychloroquine, and sulfasalazine, according to a recent study published in Arthritis Care & Research, March 2017. It’s estimated that between 1.3 million and 1.5 million adults in the U.S. have RA.
The six-year study, conducted by U.S. Veterans Affairs researchers, involved 4,364 American veterans who were RA patients.
RA treatment generally begins with methotrexate, adding sulfasalazine and hydroxychloroquine (triple therapy) or a biologic (etanercept or other TNF inhibitor). Three clinical trials have shown that the effectiveness of the triple therapy is equal or almost equal to that of combination methotrexate and an anti-TNF agent. Triple therapy is considerably less costly than the MTX + TNFi therapy, but it involves a more complicated regimen of multiple pills taken daily.
Adherence Measured. Adherence rates at 12 months were 24.2 percent for the TNFi + MTX patients and 17.3 percent for the triple therapy patients; at 24 months, adherence rates were 70 and 57 percent, respectively.
Researchers found lower adherence to sulfasalazine (30 percent) compared to all other DMARDs (40 percent), and speculated that daily therapy with hydroxychloroquine and sulfasalazine, which can require up to six tablets daily, was associated with lower persistence and adherence than once-weekly MTX injections and TNFi once-weekly or less frequent dosages.
Persistence Measured. Researchers found persistence rates were significantly higher for TNFi + MTX than for triple therapy.
Persistence rates, were defined several ways: 1) the patient continues all drugs in combination for more or less than 365 days without any gap of more than 90 days; 2) patients who responded to combination therapy and have low disease activity were allowed to interrupt or stop one or more nonbiologic DMARDs in the combination (thus reducing their use of nonbiologic DMARDs), and 3) patients were considered “persistent” during the one-year followup, even if they switched drugs within a class, as long as they did not discontinue to nonbiologic DMARD monotherapy or to no DMARD therapy.
What This Means. The study recommended tailoring treatments to individuals based on disease duration and disease activity, but, clearly, the simpler the drug regimen, the better—as shown by the study’s adherence and persistence rate.
The post RA Treatment: Simpler is Better appeared first on University Health News.
Read Original Article: RA Treatment: Simpler is Better »
Powered by WPeMatico
