DMARDs, glucocorticoids, biologics similar for treatment of RA

Treatment of rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, biologics, or a combination of these agents significantly reduces radiographic evidence of joint destruction, with no advantage seen for patients whose treatment includes biologics, according to research published in the October issue of Arthritis & Rheumatism.

Niels Graudal, MD, of the Copenhagen University Hospital, and Gesche Jürgens, MD, of the Bispebjerg University Hospital - both in Copenhagen, Denmark, reviewed 70 randomized, controlled trials that compared joint destruction in patients with RA treated with DMARDs, glucocorticoids, and/or biologics. The percentage of annual radiographic progression rates (PARPRs) was compared for the various individual and combination treatments.

Compared to placebo, the researchers found that the PARPR was 0.65% smaller in the group treated with a single DMARD and 0.54% smaller in the group treated with glucocorticoids. Compared to the group receiving a single DMARD, the PARPR was 0.62% smaller in the DMARD combination group and 0.61% smaller in the biologic plus methotrexate (MTX) group. The effect of a combination of 2 DMARDs and step-down glucocorticoids did not differ significantly from that of a biologic combined with MTX.

“A direct comparison between the combination of a biologic agent plus MTX and a double DMARD combination plus initial glucocorticoid revealed no difference. Consequently, biologics should still be reserved for DMARD-resistant patients. In the future, trials of the effect of biologics on RA should be compared with combination treatments involving DMARDs and glucocorticoids,” the authors wrote.