Mr. Duncan et Ha. Capell, THE USE OF ANTIMALARIALS IN COMBINATION WITH OTHER DISEASE-MODIFYING AGENTS IN RA - THE BRITISH-EXPERIENCE, Lupus, 5, 1996, pp. 50-58
Antimalarial drugs are effective disease modifying agents in RA with a
low incidence of serious toxic effects. Recently, combinations of sec
ond-line agents have been used in RA in attempts to treat patients wit
h no response to a number of single agents, or suboptimal response to
a single agent. Combinations of drugs have been selected for maximum e
fficacy and minimum toxicity, but clinical trials are difficult to des
ign and interpret. In particular, ensuring adequate power to detect sm
all differences in response poses a major problem. Antimalarials are a
n attractive choice for combination therapy due to their efficacy, mec
hanisms of action and toxicity profile. In this review, the evidence f
or the use of antimalarials in combination in RA is examined. No advan
tage has been shown in combining antimalarials with gold, penicillamin
e or sulphasalazine compared with monotherapeutic regimens. There is s
ome evidence to suggest a beneficial combination of antimalarials with
methotrexate, but this is as yet inconclusive. Open non-randomised un
controlled studies have shown that antimalarials combined with cytotox
ic agents are effective but highly toxic. The authors conclude that th
ere is little good evidence to support the introduction of combination
second-line drug therapy for RA into widespread therapeutic use.