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For patients with rheumatoid arthritis (RA), combinations of methotrexate with other conventional disease-modifying antirheumatic drugs (DMARDs; e.g., sulfasalazine plus hydroxychloroquine, cyclosporine) or tumor necrosis factor antagonists (TNF antagonists; e.g., infliximab, etanercept) are more effective than methotrexate alone. But some patients with early RA respond well to methotrexate alone, and the optimal strategy for sequencing these drugs remains controversial.
Swedish investigators administered methotrexate monotherapy for 3 to 4 months to 487 patients with newly diagnosed RA; 145 (30%) exhibited good clinical responses (by standard criteria). Patients who tolerated methotrexate but showed inadequate clinical responses then were r…