Healio
Healio
October 06, 2017
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Triple therapy seen as more durable vs MTX/etanercept in patients with RA who fail first MTX treatment

In patients with rheumatoid arthritis who do not respond adequately to methotrexate and are randomized to receive triple therapy or methotrexate-etanercept, triple therapy appears to be significantly more durable, according to findings.

 

“In RA patients with active disease despite MTX, the RACAT trial has shown that triple therapy is non-inferior to MTX and etanercept, and of course, dramatically more economical,” study co-author James R. O’Dell, MD, told Healio Rheumatology. “This recent follow-up study shows that triple therapy is also more durable than etanercept.”

 

 

In the observational study, researchers conducted an open-label follow-up of the 48-week RACAT trial. The RACAT trial randomly allocated patients with suboptimal response to MTX treatment to initiate additional treatment with either sulfasalazine and hydroxychloroquine (triple therapy) or etanercept (MTX-etanercept). Patients who did not show clinical benefit at 24 weeks were switched to the alternate therapy.

 

 

Overall, 289 patients consented to the open-label extended follow-up. At the conclusion of the formal 48-week trial, patients could change or continue treatment. They were invited to return for regular follow-up appointments through 72 weeks.

 

 

Researchers found the mean duration of open-label follow-up was 11 ±6 months. Patients treated with triple therapy had a 78% likelihood of continuing conventional therapy at 1 years, while patients in the MTX-etanercept group had a 63% likelihood of continuation at 1 year. Most treatment changes took place at the start of follow-up, and more patients switched from MTX-etanercept to triple therapy than from triple therapy to MTX-etanercept. In an analysis in which patients who switched therapy immediately at the start of follow-up were removed, no statistical difference in durability was seen between conventional disease-modifying antirheumatic drugs and biologic agents.

At baseline, the mean DAS28 scores were comparable between the groups and stayed consistent throughout follow-up. A trend was observed toward a reduction in DAS28 scores with conventional DMARDs and a slight trend toward an increase in DAS28 scores with biologic DMARDs, but these trends were not statistically significant.

 

 

No statistically significant differences were seen between the groups in terms of patient global health assessment scores, swollen joint counts, tender joint counts and erythrocyte sedimentation rate values. – by Jennifer Byrne

 

 

 

 

 

Disclosures:  Mikuls reports he receives consultancy fees from Pfizer and research support from Bristol-Meyers Squibb and AstraZeneca. O’Dell reports he receives consultant fees, speaking fees and/or honoraria from Medac Pharma, Antares, Eli Lilly, Coherus BioSciences and GlaxoSmithKline.

 

Sources/Disclosures

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Source:

Peper SM, et al. Arthritis Care & Res. 2016;doi:10.1002/acr.23255.