Combination treatment strategies in early rheumatoid arthritis

Suresh, Ernest; Lambert, C. M.

doi:10.1136/ard.2004.032219

Cited by 21 publications

(14 citation statements)

References 47 publications

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“…Because of the need to shut down as much inflammation as possible during the early phase of disease before onset of joint damage, there has been increased interest in recent years in giving combinations of DMARDs with different mechanisms of action 35. There are different strategies for combination therapy, but the ‘step-down’ approach used during the early phase of disease is associated with the best outcome 36.…”

Section: Combination Dmard Therapymentioning

confidence: 99%

Recent advances in rheumatoid arthritis

Suresh

2010

Postgraduate Medical Journal

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Management of rheumatoid arthritis (RA) has radically changed over the last decade. Diagnostic methods have improved with availability of highly specific tests such as antibody to cyclic citrullinated peptide (specificity approximately 96%), and introduction of advanced imaging modalities such as ultrasound and magnetic resonance imaging to facilitate earlier diagnosis. The current aim of management is to achieve remission and prevent joint damage. In order to achieve this goal, inflammation is suppressed as much as possible during the early phase of the disease before onset of joint damage. Aggressive treatments with combinations of disease modifying anti-rheumatic drugs are commenced earlier in the course of disease, and tight control maintained with regular objective monitoring of disease activity. Early use of anti-TNFalpha (tumour necrosis factor alpha) therapy in combination with methotrexate helps to achieve better clinical and radiographic outcomes, which can be maintained for up to 5 years after withdrawal of anti-TNFalpha therapy. Apart from anti-TNFalpha, several other biological treatments are now available, including those that target CD20 on B cells (rituximab), cytokines such as IL1 (anakinra) and IL6 (tocilizumab), and molecules that cause interaction between antigen presenting cells and T cells (abatacept). There is better awareness and understanding of RA associated complications such as cardiovascular disease and osteoporosis. Use of non-steroidal anti-inflammatory drugs is on the decline in light of recent concerns about cardiovascular safety. Evidence is emerging in support of statins and bisphosphonates for improving RA disease activity and preventing erosions, respectively. In the coming years, further improvements in therapeutic strategies are likely with the pace at which research is currently progressing.

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Section: Combination Dmard Therapymentioning

confidence: 99%

Recent advances in rheumatoid arthritis

Suresh

2010

Postgraduate Medical Journal

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“…Globalement, on ne dispose pas d'études comparatives contrôlées ayant clairement démontré la supériorité des associations de traitements de fond par rapport aux monothérapies, y compris lorsque le MTX est utilisé [12,13]. Plusieurs études notamment dans les PR débutantes n'ont pas retrouvé de diffé-rences entre les associations et les monothérapies [14].…”

Section: Association Du Leflunomide Avec Un Traitement De Fond Convenunclassified

Intérêt du leflunomide en association aux traitements de fond traditionnels ou aux biothérapies dans la polyarthrite rhumatoïde

Combe

2006

Revue du Rhumatisme

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“…Despite early treatment with DMARD monotherapy, many patients continue to have progressive disease21 and, therefore, combinations of drugs with different mechanisms of action are sometimes used 29. Such a strategy might allow lower doses of each drug to be used, which could result in fewer unwanted effects 30.…”

Section: Principles Of Combination Therapymentioning

confidence: 99%

“…Such a strategy might allow lower doses of each drug to be used, which could result in fewer unwanted effects 30. Combination therapy may be initiated in a sequential 'step up' approach in patients not responding to monotherapy; this might avoid administering several drugs to patients who would have responded to one 29. Alternatively, the combination of treatments may be started early in the disease, with the aim of patients receiving the most effective treatment when they are most likely to respond.…”

Section: Principles Of Combination Therapymentioning

confidence: 99%

“…Alternatively, the combination of treatments may be started early in the disease, with the aim of patients receiving the most effective treatment when they are most likely to respond. Treatment could then be reduced in a 'step down' approach once the disease was controlled, aiming to maintain remission with the most effective and/or least toxic drug 17 , 29…”

Section: Principles Of Combination Therapymentioning

confidence: 99%

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Combination therapy for early rheumatoid arthritis

Gossec

Dougados²

2006

DTB

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Around 1% of adults in the UK have rheumatoid arthritis (RA).1 UK national guidelines recommend that such people should receive disease-modifying anti-rheumatic drugs (DMARDs) as soon as possible after diagnosis, as earlier treatment is more effective in reducing disease progression.2,3 Also, it has been proposed that combination DMARD therapy may reduce joint damage more than single drugs.1,2,4 In the light of several recently published trials on combination therapy in early RA,5–14 here we update our recommendations on such treatment. 15,16

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Combination treatment strategies in early rheumatoid arthritis

Cited by 21 publications

References 47 publications

Recent advances in rheumatoid arthritis

Recent advances in rheumatoid arthritis

Intérêt du leflunomide en association aux traitements de fond traditionnels ou aux biothérapies dans la polyarthrite rhumatoïde

Combination therapy for early rheumatoid arthritis

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