EFFICACY OF TRIPLE DMARD THERAPY IN PATIENTS WITH RA WITH SUBOPTIMAL RESPONSE TO METHOTREXATE

Rheumatoid arthritis (RA) has a profound effect on patients, producing significant morbidity and in some cases mortality, Because of this, m ost rheumatologists are moving to disease modifying antirheumatic drug (DMARD) therapy earlier in the course of RA, Methotrexate (MTX) has b ecome the initial DMARD of choice for most rheumatologists. Unfortunat ely, treatment of RA with a single DMARD, including MTX, often results in a suboptimal response. Therefore, most rheumatologists are now usi ng combinations of DMARD to treat patients with RA who have had incomp lete responses to single DMARD therapy The Rheumatoid Arthritis Invest igational Network (RAIN) reported the results of a double blind, contr olled comparison of triple drug therapy (MTX-sulfasalazine-hydroxychlo roquine) against MTX alone, and against the combination of hydroxychlo roquine and sulfasalazine. Twenty-eight patients who had suboptimal re sponses to MTX or the combination of sulfasalazine and hydroxychloroqu ine were then treated with triple therapy in an open label study Fourt een had previously failed MTX therapy, and 14 had previously failed co mbination therapy with sulfasalazine and hydroxychloroquine. Both grou ps had statistically significant improvements in sedimentation rates, morning stiffness, swollen joint scores, tender joint scores, patient global status assessment, and physician global status assessment. Stat istical significance was reached for all these variables for patients in both groups, but improvement was greater for the patients in the su lfasalazine-hydroxychloroquine group. Patients with RA who have had su boptimal responses to MTX, or to the combination of sulfasalazine-hydr oxychloroquine, show both statistical and clinically significant impro vement in multiple clinical variables when treated with the combinatio n of MTX 17.5 mg/week, sulfasalazine 500 mg bid, and hydroxychloroquin e 200 mg bid.