Early Treatment for Rheumatoid Arthritis. Posted Aug 10, Dubai, United Arab Emirates

Investigators say TNF blockers may benefit certain patients with early RA.
HealthDay (8/6, Preidt) reported, "Patients with early rheumatoid arthritis (RA) who respond poorly to standard treatment with methotrexate may benefit from additional treatment with tumor necrosis factor (TNF) blockers," according to a Swedish study published in The Lancet. "Previous research has shown that 20 to 40 percent of patients have a good response to methotrexate therapy and don't need more intensive combination treatment." Aiming to find a way to help the remaining percentage, researchers looked to "487 patients with early RA (less than one year's duration) who were initially treated with methotrexate." Some three to four months after treatment started, "the 258 patients with an inadequate response to methotrexate were randomly assigned to receive either the TNF blocker infliximib (Remicade) or the conventional disease-modifying antirheumatic drugs [DMARDs], sulfasalazine and hydroxychloroquine."
According to WebMD (8/6, Hitti), "one year later, 39 percent of the patients taking methotrexate plus Remicade had only low levels of RA symptoms, compared to 25 percent of patients taking methotrexate plus sulfasalazine and hydroxychloroquine." Lead investigator R.F. van Vollenhoven, MD, was quick to point out that the "difference between the two groups didn't happen right away; the Remicade-plus-methotrexate group took the lead after six months of treatment." Nevertheless, "the researchers aren't recommending anti-TNF drugs for everyone with RA, because anti-TNF drugs are more expensive than conventional drugs and aren't always needed or appropriate."
MedPage Today (8/6, Gever) quoted the authors, "In patients with early rheumatoid arthritis in whom methotrexate treatment failed, addition of a tumor necrosis factor antagonist to methotrexate monotherapy is clinically superior to addition of conventional disease-modifying antirheumatic drugs." The authors of an accompanying editorial, however, "argued that the study should not be interpreted as showing that infliximab is superior to oral DMARDs as the proper partner with methotrexate." In fact, "they noted that a statistical advantage can be found for biologic agents, even though only 20 percent of patients with suboptimal response to methotrexate do better on them." In other words, "the most important information to be gathered from clinical trials in rheumatoid arthritis is not necessarily comparisons of agents, but rather the strategy of tight control, aiming for remission."