THU0187 Do we today alternative therapies rheumatoid arthritis two or more disease-modifying drugs? the story of how a simple drug pentoxifylline may enhance the action of methotrexate in rheumatoid arthritis

Abstract

BackgroundThe treatment of patients with RA (rheumatoid arthritis) is a complicated task, because the achievement of remission and low level of activity often requires administration of 2–3 disease-modifying drugs. In such conditions we often face with the rise of treatment costs and with the increase of therapy side effects. That is why relevant is the search of the drugs increasing the effect of the “gold standard” of RA – therapy - methotrexate, and also frequently used sulphasalazine and leflunomid. Treatment of prior to “Treat to target” is difficult enough, forcing researchers around the world to look for the ways to improve the effectiveness of RA treatment.ObjectivesTo explore the possibilities of reducing RA activity on the disease activity score DAS28 CRP by adding pentoxifylline to the methotrexate, sulfasalazine and leflunomide treatment.MethodsThis study included women (n=131) with RA longer than 1 year in duration, having a seropositive rheumatoid factor, and DAS28 CRP activity score of 3.2–5.1. Middle aged – 46.44±3.24 years old. All patients received a 15.50±2.50 mg oral dose of methotrexate per week, 2000±500 mg oral dose of sulfasalazine per day, 20±5 mg oral dose of leflunomide per day. Patients were divided into two groups - those who only had disease-modifying drugs (DMARDs) (n=80) and those who were treated with an oral dose of methotrexate and 1200 mg of pentoxifylline per day (n=51).ResultsThe baseline for both groups of RA patients did not differ significantly in terms of the level on the DAS28 CRP (p=0.812). On 14th day of the group who were taking pentoxifylline, the DAS28 CRP disease activity score was significantly lower by 12.5% (p<0.001). After 28 days, the users had a DAS28 CRP disease activity score index difference. The difference between two groups is statistically significant. In the group that were treated with pentoxifylline in addition to DMARDs (p=0.001) the index was found to be 8.3% lower. For 28 days, the methotrexate group's disease activity according to the DAS28 CRP activity score significantly decreased by 14.3% from the baseline (p<0.001). For 28 days, the pentoxifylline + DMARDs group also achieved a statistically significant reduction in the index according to the DAS28 CRP activity score by 20.5% (p<0.001)The disease activity index for the two groups for 14 and 28 days is shown in the table.The DAS28 CRP Index in the two groups of RA patientsGroups of patients Observation timeGroup DMARDs (n=80)Group DMARDs + Pentoxifylline (n=51)Statistical significant differences between the two groups Baseline3.11±0.053.13±0.05p=0.812For 14 days3.06±0.052.69±0.06p<0.001For 28 days2.71±0.042.48±0.06p=0.001ConclusionsThus, converting the monotherapy DMARDs to pentoxifylline will significantly reduce the activity of RA, while avoiding many of the adverse effects of the other combination therapies. This data requires further long-term research.Disclosure of InterestNone declared