Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis

Objective The response to single disease modifying antirheumatic drug (DMARD) is ofte n suboptimal in patients with rheumatoid arthritis (RA). Thus, despite the limited data on the therapeutic efficacy of combination therapies many pati ents are currently treated with a combination of DMARDs. Methods We studied prospectively the efficacy of combination therapy with DMARDs. T he study was designed as a randomized trial and a single DMARD or two or th ree DMARD combinations were adminstered to 180 consecutive, age- and sex-ma tched patients with active RA, each of whom was followed up for a period of 2 years under treatment. Patients were divided into 3 groups which did not differ with regard to demographic, clinical and laboratory parameters. Pat ients in group I were treated with a single DMARD [methotrexate (MTX) 7.5 - 15 mg/week or sulfasalazine (SSZ) 1 - 2 g/day or hydroxychloroquine (HCQ) 200 mg/day], group II with MTX + SSZ or MTX + HCQ, and group III with a com bination of all three drugs. Patients were re-evaluated at regular interval s by means of clinical and biochemical tests designed to detect specific rh eumatic activity. Radiological assessments were also performed and scored a ccording to Larsen by the same radiologist who was blinded to the treatment groups. Results At the end of the trial there were significant improvements in the clinical and laboratory parameters in all 3 groups. However, improvements were grea ter and much more significant in the patients who were given combination th erapies. The combination of MTX + SSZ + HCQ was move effective than both mo notherapy and the two-drug combinations. Conclusion In conclusion, we suggest that patients with RA should be treated with comb inations of DMARDs.