Utility of disease modifying antirheumatic drugs in "sawtooth" strategy. Aprospective study of early rheumatoid arthritis patients up to 15 years

Objectives-To study long term utility of early continual, and serial use of disease modifying antirheumatic drugs (DMARDs) in early rheumatoid arthrit is (RA) in clinical setting. Methods-A total of 135 patients with early RA were treated according to the "sawtooth" strategy and prospectively followed up to lj years. DMARD survi vals as well as reasons for drug terminations were documented and are repor ted here. Results-During 1401 person years of follow up, a DMARD or a combination of two or several DMARDs (COMBOs) was started 606 times. A total of 528 drug p eriods were terminated because of inefficacy, adverse effects, remission, a nd other reasons in respective 270 (51.1%), 149 (28.2%), 32 (6.1%), and 77 (14.6%) cases. Severe drug related adverse events mere rare. The median dur ation of DMARD periods of individual DMARDs or COMBOs was 10 months ranging from six to 18 months. Not a single DMARD/COMBO stood out favourably from the others with respect to inefficacy, toxicity or drug survival. Conclusion-The use of serial DMARDs/COMBOs was safe even in the long run. I nefficacy rather than toxicity was the leading reason for drug terminations . More powerful drug therapies are needed.