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No difference in efficacy for MTX as monotherapy vs. combination therapy with other csDMARDs for RA
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In a systematic literature review informing the 2016 update to the European League Against Rheumatism recommendations for the management of rheumatoid arthritis, methotrexate as monotherapy was found to be no less effective as combination therapy with conventional synthetic disease-modifying antirheumatic drugs.
Researchers also found the addition of glucocorticoids to conventional synthetic disease-modifying antirheumatic drug therapy may be beneficial, but should be balanced against risks for toxicity and tofacitinib and baricitinib were effective in patients with rheumatoid arthritis.
Katerina Chatzidionysiou, MD, PhD, in the Department of Rheumatology at Karolinska University Hospital in Sweden, and colleagues performed a systematic literature review of randomized clinical trials conducted between 2013 and 2016 to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and the targeted synthetic DMARDs (tsDMARDs) tofacitinib and baricitinib.
For GCs, there were four studies that demonstrated patients without poor prognostic factors experienced benefits after GCs were added to methotrexate (MTX).
“Lower doses of GCs were similar to higher doses,” the researchers wrote.
For csDMARDs, there were two studies that showed no difference in efficacy between MTX as monotherapy vs. MTX as combination therapy with other csDMARDs. For tsDMARDs, both tofacitinib and baricitinib were more effective than placebo. – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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