Therapies for Active Rheumatoid Arthritis after Methotrexate Failure

• Published in: The New England journal of medicine Vol. 369; no. 4; pp. 307 - 318
• Main Authors: O'Dell, James R, Mikuls, Ted R, Taylor, Thomas H, Ahluwalia, Vandana, Brophy, Mary, Warren, Stuart R, Lew, Robert A, Cannella, Amy C, Kunkel, Gary, Phibbs, Ciaran S, Anis, Aslam H, Leatherman, Sarah, Keystone, Edward
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 25.07.2013
• Subjects: Aged; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Clinical trials; Diseases of the osteoarticular system; Double-Blind Method; Drug therapy; Drug Therapy, Combination; Etanercept; Female; General aspects; Humans; Hydroxychloroquine; Hydroxychloroquine - adverse effects; Hydroxychloroquine - therapeutic use; Immunoglobulin G - adverse effects; Immunoglobulin G - therapeutic use; Inflammatory joint diseases; Male; Medical sciences; Methotrexate; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Pain; Patients; Quality of life; Receptors, Tumor Necrosis Factor - therapeutic use; Rheumatoid arthritis; Severity of Illness Index; Sulfasalazine; Sulfasalazine - adverse effects; Sulfasalazine - therapeutic use; TNF inhibitors; Treatment Failure; Antineoplastic agent; Immunopathology; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Antifolate; Medicine; Chronic; Treatment; Antimetabolic; Rheumatoid arthritis; Methotrexate; Failure
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1303006

In a 48-week trial in patients with active rheumatoid arthritis despite treatment with methotrexate, adding sulfasalazine and hydroxychloroquine to methotrexate was not inferior to adding etanercept. The prognosis for patients with rheumatoid arthritis has improved dramatically over the past two decades. 1 , 2 The reasons for the improved prognosis include earlier diagnosis, treatment targeted to low disease activity or remission, the use of disease-modifying antirheumatic drugs (DMARDs) in combinations, and the availability of biologic therapies. 1 – 4 A substantial portion of patients who are diagnosed today will have a clinical remission with therapy. 1 , 2 , 5 , 6 Unfortunately, the cost of treating rheumatoid arthritis has also risen dramatically, and this disease is now more expensive to treat than diabetes, 7 largely as a consequence of the biologic therapies. Most clinicians . . .