Hiroaki Matsuno1, Masato Okada2, Yoshitada Sakai3, Chiyuki Abe4, Kou Katayama5, Akira Sagawa6, Kuniomi Yamasaki7, Masakazu Kondo8, Keiko Funahashi9, Tsukasa Matsubara10. 1. a Matsuno Clinic for Rheumatic Diseases , Toyama , Japan. 2. b Immuno-Rheumatology Center, St. Luke's International Hospital , Tokyo , Japan. 3. c Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine , Kobe , Japan. 4. d Abe Clinic , Tokyo , Japan. 5. e Katayama Orthopedic Rheumatology Clinic , Toyooka, Asahikawa , Japan. 6. f Sagawa Akira Rheumatology Clinic , Sapporo , Japan. 7. g Shin Yokohama Yamasaki Clinic , Yokohama , Japan. 8. h Kondo Clinic of Rheumatology and Orthopaedic Surgery , Fukuoka , Japan. 9. i Kansetsu Saisei Kenkyujo , Kobe , Japan. 10. j Matsubara Mayflower Hospital , Kato , Japan.
Abstract
OBJECTIVES: Combination treatment with methotrexate, salazosulfapyridine and bucillamine as an alternative to treatment with TNF-inhibiting biologics in rheumatoid arthritis was investigated. METHODS: Twenty-six facilities allied with the Japan Association of Rheumatologists in Private Practice participated in this study. One hundred and twelve patients enrolled in this study, all of whom were within 3 years of diagnosis with rheumatoid arthritis for whom treatment with one DMARD or a combination of two DMARDs had failed (DAS28 > 3.2). Patients chose their own treatment. The triple DMARDs combination group was comprised of 72 patients; the TNF-inhibiting biologics treatment group was comprised of 40 patients. RESULTS: DAS28 scores for the triple DMARDs combination group and the TNF-inhibiting biologics treatment groups were 4.84 ± 0.96 and 5.23 ± 1.26, and there was no significant difference between the two groups. From the 6th month, average disease activities of both groups were reduced, and there was no difference between the two groups at 12 months (DAS28, 3.39 ± 1.43 and 3.05 ± 1.43, p = 0.39). Furthermore, there was no significant difference in the degree of bone destruction between the two groups at 12 months. CONCLUSIONS: The triple DMARD combination therapy provided a new treatment option for those patients for whom treatment with biologics is difficult.
OBJECTIVES: Combination treatment with methotrexate, salazosulfapyridine and bucillamine as an alternative to treatment with TNF-inhibiting biologics in rheumatoid arthritis was investigated. METHODS: Twenty-six facilities allied with the Japan Association of Rheumatologists in Private Practice participated in this study. One hundred and twelve patients enrolled in this study, all of whom were within 3 years of diagnosis with rheumatoid arthritis for whom treatment with one DMARD or a combination of two DMARDs had failed (DAS28 > 3.2). Patients chose their own treatment. The triple DMARDs combination group was comprised of 72 patients; the TNF-inhibiting biologics treatment group was comprised of 40 patients. RESULTS: DAS28 scores for the triple DMARDs combination group and the TNF-inhibiting biologics treatment groups were 4.84 ± 0.96 and 5.23 ± 1.26, and there was no significant difference between the two groups. From the 6th month, average disease activities of both groups were reduced, and there was no difference between the two groups at 12 months (DAS28, 3.39 ± 1.43 and 3.05 ± 1.43, p = 0.39). Furthermore, there was no significant difference in the degree of bone destruction between the two groups at 12 months. CONCLUSIONS: The triple DMARD combination therapy provided a new treatment option for those patients for whom treatment with biologics is difficult.