Adding sulfasalazine plus hydroxychloroquine was noninferior to adding etanercept.
In methotrexate-treated patients with rheumatoid arthritis (RA), how does the addition of a biologic agent compare with addition of two conventional nonbiologic agents? This question was addressed in a double-blind, placebo-controlled, randomized trial that involved 353 RA patients who had received 15 to 25 mg of methotrexate weekly for at least 12 weeks and who required additional treatment.
While continuing methotrexate, patients received either sulfasalazine plus hydroxychloroquine (“triple therapy”) or the tumor necrosis factor (TNF) inhibitor etanercept (Enbrel). The primary endpoint was improvement in the DAS28, a composite index that includes both objective and subjective measures of disease activity. With blinding maintained, patient…