Comparison of Four Treatment Regimens for RA

Two combination drug regimens outperformed two regimens that began with monotherapy.

Numerous options now exist for early treatment of patients with rheumatoid arthritis (RA). In this Dutch trial, 508 patients with early RA were randomized to 4 groups:

group 1: sequential monotherapy (start with methotrexate, switch to sulfasalazine if response is inadequate)
group 2: step-up therapy (start with methotrexate, add sulfasalazine if response is inadequate)
group 3: combination therapy with prednisone (initiate treatment with methotrexate, sulfasalazine, and 60 mg prednisone daily; taper prednisone during 7 weeks to 7.5 mg daily)
group 4: combination therapy with infliximab (initiate treatment with methotrexate plus infliximab)

Detailed algorithms outlined additional treatments for patients with inadequate responses and reductions i…

Reviewing Author

Allan S. Brett, MD