If standard treatment fails, more intensive therapy works well, study finds
THURSDAY, Aug. 6 (HealthDay News) -- Patients with early rheumatoid arthritis (RA) who respond poorly to standard treatment with methotrexate may benefit from additional treatment with tumor necrosis factor (TNF) blockers, a Swedish study suggests.
Previous research has shown that 20 percent to 40 percent of patients have a good response to methotrexate therapy and don't need more intensive combination treatment.
This new study included 487 patients with early RA (less than one year's duration) who were initially treated with methotrexate. After three to four months, the 258 patients with an inadequate response to methotrexate were randomly assigned to receive either the TNF blocker infliximib (Remicade) or the conventional disease-modifying antirheumatic drugs, sulfasalazine and hydroxychloroquine.
After 12 months, 39 percent of patients given infliximib achieved a good response, compared with 25 percent of patients given sulfasalazine and hydroxychloroquine.
"We believe that by treating all patients with methotrexate for 3 to 4 months, we screened out a sizeable proportion [30 percent in this trial] who would have been overtreated if aggressive combination therapy was used for all, an approach that could have increased the risk of side effects and potentially entailed high costs," wrote the researchers from the Karolinska University Hospital and the Karolinska Institute.
A short period of treatment with methotrexate alone, followed by the addition of a TNF blocker only in patients who have an inadequate response to methotrexate, is the best treatment option for patients with early RA, they concluded.
The study appears in this week's edition of The Lancet.
In related news, the U.S. Food and Drug Administration on Tuesday ordered that TNF blockers carry an updated "black box" label to warn doctors and patients that the drugs may increase the risk of cancer in children and adolescents.
The Arthritis Foundation has more about rheumatoid arthritis.
-- Robert Preidt
SOURCE: The Lancet, news release, Aug. 6, 2009
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