Triple conventional synthetic DMARD therapy may lower disease activity in RA patients: Study

A recent study published in the Joint Bone Spine journal unveiled comparative insights into the effectiveness of conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) treatment strategies for rheumatoid arthritis (RA), focusing on patient retention rates between two popular treatment combinations. This study provides important data on the real-world application of triple therapy (methotrexate, sulfasalazine and hydroxychloroquine) against the double therapy (methotrexate and leflunomide) by offering valuable guidance for clinicians and patients who navigate RA treatment options.

The comprehensive research from the Ontario Best Practices Research Initiative (OBRI) included a total of 692 RA patients and grouped them based on their treatment regimen. 258 patients were on triple therapy and 434 patients were on double therapy and were followed up from enrollment. The primary goal was to analyze and compare the retention rates of these treatment strategies that provide insight into their long-term viability and effectiveness.

The study found a close competition between the two treatment approaches in terms of patient retention. The triple therapy group had a median treatment duration of 15.1 months a bit longer than the 9.6 months observed in the double therapy group. Despite this difference, the statistical analysis revealed no significant difference between the therapy groups which hints a comparable effectiveness between the two strategies.

The data showed that at 6 and 12 months, the patients on triple therapy expressed lower disease activity levels than the individuals on double therapy based on based on the erythrocyte sedimentation rate (DAS28-ESR) calculated by the 28-joint count Disease Activity Score. Also, mean DAS28 scores were lower for the triple therapy group at both intervals by illuminating the potential for enhanced quality of life and symptom management with this treatment combination.

This study explored reasons behind treatment discontinuation and identified risk factors by enriching the concern around patient oriented care and personalized treatment planning. This aspect of the research emphasizes the importance of understanding patient experiences and outcomes beyond mere statistical comparisons to foster a more precise approach to manage RA.

While these findings did not establish a statistically significant superiority of one treatment over the other and underline the nuanced landscape of RA treatment. The slight edge in retention time and reduced disease activity scores with triple therapy could influence the future clinical guidelines and patient preferences by highlighting the importance of tailored treatment strategies in managing RA.

Reference:

Bhavsar, S. V., Movahedi, M., Cesta, A., Pope, J. E., & Bombardier, C. (2024). Retention of triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine compared to combination methotrexate and leflunomide in rheumatoid arthritis. In Joint Bone Spine (p. 105732). Elsevier BV. https://doi.org/10.1016/j.jbspin.2024.105732