Early RA disease activity lower with methotrexate combination than methotrexate alone
medwireNews: Methotrexate (MTX)–hydroxychloroquine (HCQ) combination therapy is associated with lower disease activity than MTX alone in early rheumatoid arthritis (RA), according to a head-to-head comparison published in Rheumatology.
The 79 individuals receiving MTX monotherapy had an average 1.2-point decrease in their mean Disease Activity Score at 28 joints based on C-reactive protein (DAS28-CRP) at 6 months, whereas the 246 individuals taking MTX–HCQ combination therapy had an average gain of 1.7 points. This gave a significant difference of 0.38 points, after taking into account confounding factors such as age, sex, rheumatoid factor positivity, mean dose over the first 6 months, and administration route of MTX.
There was also a significant difference in the proportion of patients who showed a good EULAR response at 6 months, at a rate of 46% in the monotherapy group versus 61% in the combination group.
Significant differences were not seen at 12 months, however. The average decrease in DAS28-CRP from baseline to 12 months was 1.5 points in the monotherapy group and 1.8 points in the combination therapy group (adjusted difference of 0.22 points), and a good EULAR response was seen in 60% and 66% of individuals, respectively.
Lisa Schapink (Sint Maartenskliniek, Nijmegen, the Netherlands) and study co-authors speculate that this disappearance of outcome differences at 12 months “is probably due to treatment intensification in the monotherapy group,” as 42% of patients in the monotherapy group started an extra conventional synthetic DMARD, compared with just 11% in the combination group. The cumulative incidence of biologic DMARD therapy was similar between the two groups, at 17% and 19%, respectively.
This was a prospective observational study in which researchers collected data from adults with RA who received MTX 25 mg/week or MTX–HCQ 400 mg/day as their first DMARD for a year.
Although the researchers did not collect data about adverse events, they note that they would not expect a big difference in adverse events between the two groups because “HCQ is generally seen as a relatively non-toxic agent.”
They conclude: “Although this study showed only a modest gain in disease control, this combination could be an attractive option, in part because HCQ has low risk for side effect[s] and low costs.”
By Catherine Booth
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