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Higher doses of fish oil helped RA patients achieve remission
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Patients with rheumatoid arthritis who received a higher dose of fish oil, along with triple disease-modifying antirheumatic drug therapy and methotrexate achieved lower drug failure and greater remission, according to recent study results.
Researchers in Australia studied 139 patients with rheumatoid arthritis (RA) of less than 12 months’ duration who were disease-modifying antirheumatic drug (DMARD)-naive. The patients were randomly assigned 5.5 grams daily (fish oil [FO] group; n=86; 71% women) or 0.4 grams per day (control group; n=53; 75% women) of the omega-3 fats eicosapentaenoic acid plus docosahexaenoic acid. Methotrexate (MTX, 10 mg orally weekly), folic acid (500 mcg daily), sulfasalazine (500 mg daily, increasing to 1 g twice daily over 4 weeks) and hydroxychloroquine (200 mg twice daily) were used to treat all patients.
An algorithm, accounting for disease activity and toxicity, was used to adjust DMARD doses. Failure of triple DMARD therapy was defined as the primary outcome measure.
Susanna M. Proudman
Nine FO patients (10.5%) and 17 control patients (32.1%) advanced to leflunomide, indicating therapy failure, at 1 year. Failure of triple DMARD therapy was lower in the FO group (HR=0.28; 95% CI, 0.12-0.63) and also after adjustment for smoking history, shared epitope, and baseline anti-cyclic citrullinated peptide (HR=0.24; 95% CI, 0.1-0.54). In FO patients, the rate of first ACR remission was significantly greater when compared with controls (unadjusted HR=2.17; 95% CI, 1.07-4.42; adjusted HR=2.09; 95% CI, 1.02-4.30). No differences in MTX dose, DAS28 or modified Health Assessment Questionnaire scores were found between groups.
“In patients with early DMARD-naive rheumatoid arthritis, fish oil was associated with benefits additional to those achieved by combination treat-to-target DMARDS with similar methotrexate use,” researcher Susanna M. Proudman, MBBS (Hons), FRACP, of the University of Adelaide and senior consultant in rheumatology, Royal Adelaide Hospital, told Healio.com. “Because a structured treatment algorithm that was responsive to disease activity and tolerance was used, drug use could be used as an outcome measure for the effects of fish oil.”
Disclosure: The researchers report no relevant financial disclosures.
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