Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial

Vollenhoven, Ronald F. van; Ernestam, Sofia; Geborek, Pierre; Petersson, Ingemar F; Cöster, L; Waltbrand, Eva; Zickert, Agneta; Theander, J; Thörner, Ake; Hellstrom, H. Richard; Teleman, Annika; Dackhammar, Christina; Akre, F.; Forslind, Kristina; Ljung, Lotta; Oding, Rolf; Chatzidionysiou, Aikaterini; Wörnert, Margareta; Bratt, Johan

doi:10.1016/s0140-6736(09)60944-2

Cited by 276 publications

(220 citation statements)

References 22 publications

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“…In order to increase the homogeneity of the studied patient cohort, we included only patients from the early arthritis register who were initially treated with the first‐line DMARD, MTX. We chose 3 months as a followup, since this time period was earlier defined as adequate time for assessment of relevant clinical response after MTX treatment in RA 14, and we note in this observational cohort (EIRA) that nonresponders at 3 months often receive other or additional treatment at that time point, while most good responders remained on the same treatment 15. The rates of EULAR clinical good response in the present study were in line with earlier investigations 14, 15.…”

Section: Discussionsupporting

confidence: 83%

“…We chose 3 months as a followup, since this time period was earlier defined as adequate time for assessment of relevant clinical response after MTX treatment in RA 14, and we note in this observational cohort (EIRA) that nonresponders at 3 months often receive other or additional treatment at that time point, while most good responders remained on the same treatment 15. The rates of EULAR clinical good response in the present study were in line with earlier investigations 14, 15. Since the data were collected in a register in an unselected population of early RA patients, as part of standard care, this study should reflect the clinical setting and have a high external validity.…”

Section: Discussionmentioning

confidence: 99%

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Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

Arthritis Care & Research

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ObjectiveTo investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response.MethodsThe study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS).ResultsRemaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response).ConclusionThese results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

Arthritis Care & Research

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“…The results from the BeSt and SWEFOT (Swedish Farmacotherapy) trials indicate that step-up therapy using sulfasalazine (SSZ) and hydroxychloroquine (HCQ) in these patients is inferior to the addition of a TNF inhibitor. 60,74,75 In contrast, the results of the TEAR trial suggest that step-up treatment using SSZ and HCQ is comparably effective to step-up etanercept therapy in both clinical response and radiographic outcomes. 65,66 To mitigate this apparent contradiction, we have considered data regarding the probability of remission at 1 year on the basis of absolute disease activity at 3 months.…”

Section: Critical Time Pointmentioning

confidence: 96%

My Treatment Approach to Rheumatoid Arthritis

Davis

Matteson

2012

Mayo Clinic Proceedings

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The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival.

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“…advantage to combining MTX with other DMARDs compared to MTX alone when treating MTX naïve or MTX non-responder patients (43). The only combination with a better risk/benefit profile than MTX alone was MTX + Hydroxychloroquine + Sulfasalazine (44). Two recent studies have compared the efficacy and safety of this triple combination therapy to that of anti-TNF, revealing that the addition of a biological drug (not only anti-TNF) improves both clinical and radiological outcomes (45)(46)(47)(48).…”

Section: Recommendation 9: Methotrexate As the First Choice In Rheumamentioning

confidence: 99%

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

et al. 2013

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summaryThe objective of this review is to update the recommendations of the 2010 Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) and other rheumatic diseases. The literature published between 2008 and 2012 was systematically reviewed and updated recommendations on MTX use in rheumatic diseases, particularly RA, were formulated. These recommendations were approved by a panel of expert Italian Rheumatologists. A total of 10,238 references were identified, among which 70 studies were selected for critical evaluation. Sufficient evidence had accumulated to warrant changes to several of the recommendations in the new version. A new recommendation for patients with RA who are in MTX-induced clinical remission was also proposed and approved by the panel. Updated recommendations for the use of MTX in patients with RA or other rheumatologic disease are proposed.

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Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial

Cited by 276 publications

References 22 publications

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

My Treatment Approach to Rheumatoid Arthritis

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

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