Low Persistence Rates in Patients With Rheumatoid Arthritis Treated With Triple Therapy and Adverse Drug Events Associated With Sulfasalazine

Erhardt, Daniel P.; Cannon, Grant W.; Teng, Chia‐Chen; Mikuls, Ted R.; Curtis, Jeffrey R.; Sauer, Brian C.

doi:10.1002/acr.23759

Cited by 24 publications

(17 citation statements)

References 27 publications

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“…Patients with RA are more likely to be persistent and adherent to combination therapy with a tumor necrosis factor alpha inhibitor and methotrexate than combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine. (47,48) There are a number of limitations to these analyses. To start, this was a post hoc observational study.…”

Section: Discussionmentioning

confidence: 99%

The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative

et al. 2020

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This study was conducted to evaluate the extent to which disease-modifying antirheumatic medications (DMARDs) used as part of a triple therapy for the treatment of rheumatoid arthritis (RA) including methotrexate, sulfasalazine, and hydroxychloroquine are associated with fractures in postmenopausal women with RA. Incident fractures following use of methotrexate, sulfasalazine, and/or hydroxychloroquine in postmenopausal women with RA in the Women's Health Initiative were estimated by Cox proportional hazards using hazard ratios (HRs) and 95% CIs after consideration of potential confounders. There were 1201 women with RA enrolled in the Women's Health Initiative included in these analyses, of which 74% were white, 17% were black, and 9% were of other or unknown race/ethnicity. Of the women with RA, 421 (35%) had not used methotrexate, sulfasalazine, or hydroxychloroquine, whereas 519 (43%) women had used methotrexate, 83 (7%) sulfasalazine, and 363 (30%) hydroxychloroquine alone or in combination at some time during study follow-up. Over a median length of 6.46 years of follow-up, in multivariable adjusted models, no statistically significant association was found between methotrexate (HR, 1.1; 95% CI, 0.8-1.6), sulfasalazine (HR, 0.6; 95% CI, 0.2-1.5), or hydroxychloroquine (HR, 1.0; 95% CI, 0.7-1.5) use and incident fractures or between combination therapy with methotrexate and sulfasalazine or methotrexate and hydroxychloroquine use (HR, 0.9; 95% CI, 0.5-1.6) and incident fractures. In conclusion, postmenopausal women with RA receiving any component of triple therapy should not be expected to have any substantial reduction in fracture risk from use of these DMARDs.

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Section: Discussionmentioning

confidence: 99%

The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative

et al. 2020

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“…This recommendation is strongly in favor of methotrexate despite very low-certainty evidence for hydroxychloroquine and low-certainty evidence for sulfasalazine based on the amount of data supporting the disease-modifying properties of methotrexate monotherapy compared to hydroxychloroquine or sulfasalazine and concerns over the long-term tolerability of sulfasalazine (13,14).…”

Section: Methotrexate Is Strongly Recommended Over Hydroxychloroquine or Sulfasalazine For Dmardnaive Patients With Moderate-to-high Disementioning

confidence: 99%

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Fraenkel

Bathon

England

et al. 2021

Arthritis Care & Research

638

374

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Objective To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. Methods We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results The guideline addresses treatment with disease‐modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high‐risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). Conclusion This clinical practice guideline is intended to serve as a tool to support clinician and patient decision‐making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision‐making process based on patients’ values, goals, preferences, and comorbidities.

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“…Although this combination seems to have a good effect (if not the best among csDMARD combinations), taking three different medications concomitantly has been associated with low persistence [50].…”

Section: Combining Conventional Synthetic Disease-modifying Antirheummentioning

confidence: 99%

Conventional disease-modifying agents in rheumatoid arthritis – a review of their current use and role in treatment algorithms

Padjen¹,

Crnogaj²,

Anić³

2020

Reumatologia

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Despite the development of targeted therapies, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) remain the cornerstone of treatment of rheumatoid arthritis (RA). A literature search was conducted on treatment recommendations and relevant papers regarding new insights on therapeutics in rheumatoid arthritis. Methotrexate is considered the “anchor drug” due to its high efficacy as monotherapy and in combination with other conventional and targeted agents. Leflunomide and sulfasalazine are sound alternatives, whereas (hydroxy)chloroquine is primarily used in combination with other csDMARDs.<br /> Their use is encouraged in all treatment phases – in combination with targeted agents, and with other csDMARDs. Combining different csDMARDs is especially attractive in lower income settings given the evidence proving (almost) equal efficacy and safety of the csDMARD combination approach compared to the combination of targeted agents with a csDMARD.<br /> The aim of this review is to provide a clinically oriented insight into the pharmacology of each csDMARD and their place in treatment algorithms.

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Low Persistence Rates in Patients With Rheumatoid Arthritis Treated With Triple Therapy and Adverse Drug Events Associated With Sulfasalazine

Abstract: Differences in persistence and adherence between the MTX-TNFi and triple therapy groups appear to be primarily related to ADE that were most often attributed to SSZ. This article is protected by copyright. All rights reserved.

Cited by 24 publications

References 27 publications

The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative

The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Conventional disease-modifying agents in rheumatoid arthritis – a review of their current use and role in treatment algorithms

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