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Fitzgerald Health Education Associates, Inc., December 2014 fhea.com
side effects, and at a significantly lower cost.
Investigators at the University Hospitals Leuven, Bel-
gium, sought to find the best combination and dosage
of three commonly prescribed antirheumatic drugs
for early RA (methotrexate, sulfasalazine, and lefluno -
mide) in combination with glucocorticoids. The 2-year
study (CareRA) divided 290 early RA patients into three
treatment groups, each of which received a different
combination therapy: "classic" (metho trexate, sulfasa -
zine, and a high first dose of glucocorticoids), "slim"
(methotrexate and a moderate dose of glucocorti-
coids), or "avant-garde" (methotrexate, leflunomide,
and a moderate dose of glucocorticoids).
All three arms showed similar high efficacy, with
7 of 10 patients achieving disease remission after 16
weeks of treatment. However, there were significant
differences between the groups with respect to side
effects. The investigators reported that the slim
strategy, which has the least amount of medication
and was less complicated to implement in practice,
had half as many side effects as the other two arms
but was just as effective.
The researchers concluded that the slim strategy
would lead to higher remission rates in early RA pa-
tients and would likely reduce the need for costly
second-line antirheumatic treatments. The abstract
of the study is available
here .
An earlier study published in The New England
Journal of Medicine (2013;369:307-318) also found
that RA patients with active disease despite metho -
trexate therapy who took a three-drug regimen of
methotrexate, sulfasalazine, and hydroxychloro-
quine realized as much improvement in symptoms
as those who took methotrexate and etanercept
(Enbrel), an injectable biologic.
Investigators from the Omaha VA Medical Center in
Nebraska concluded that a strategy of first adminis-
tering this triple therapy, with a switch to etanercept-
methotrexate in patients who do not have an ade -
quate response to triple therapy, will allow a substan-
tial percentage of patients to be treated in a more
cost-effective way without adversely affecting the
clinical outcomes. The study can be found
here .
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