Radiographic progression in early rheumatoid arthritis: a 12-month randomized controlled study comparing the combination of cyclosporin and methotrexate with methotrexate alone

Abstract

In patients with early RA, CsA + MTX combination therapy led to a significantly lower rate of 12-month radiographic progression, was effective on inflammatory articular symptoms, and was well tolerated.

Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis

“…Theoretically DMARD co-prescribing could mask this benefit of glucocorticoids 52. Our results confirm previous RCTs showing adding ciclosporin to methotrexate without glucocorticoids reduces erosive damage;18 19 21 though other DMARD combinations may not reduce erosive damage 16 20 25 – 27. Overall RCTs of intensive therapy suggest two DMARDs and glucocorticoids is the optimal conventional treatment for early RA.…”

“…We used Larsen scores, which were used in RCTs by Kirwan3 and other investigators15 19 21 24 and comparable observational studies 6 56 . Other RCTs use Sharp scores;3 12 13 16 – 18 23 25 – 27 one used both Rattingen (Larsen variant) and Sharp scores 22. The relative utility of different x-ray scores is contentious 57 – 59.…”

DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis

“…In patients with recent-onset rheumatoid arthritis, several combinations of disease-modifying antirheumatic drugs (DMARDs) or biological agents1 2 3 4 5 6 7 8 9 have proven superiority over initial monotherapy in improving clinical and radiographic outcomes. In the recently performed BeSt study,10 four different treatment strategies were compared in a setting of tight disease control.…”

Combination therapy for early rheumatoid arthritis

“…Since this review, several more randomised controlled trials of such therapy in early RA have been published 5–14. The primary outcome measures of these and other studies32–38 not included in the review are discussed below. Outcome measures included:…”

“…In a second trial, 61 patients with untreated RA received intramuscular methotrexate (initially 10-15mg weekly) with or without ciclosporin (initially 3mg/kg daily) for 12 months 38. The damage score measuring radiographic progression was less among patients treated with the combination (mean 1.93 [95% CI 0.16-3.70] vs. 7.47 [95% CI 3.49-11.44] on methotrexate alone, p=0.018).…”