DMARDs should remain first-choice drugs in RA

Published: 2010-08-17

A systematic review and meta-analysis of published research indicates that in patients with rheumatoid arthritis (RA), combinations of disease-modifying anti-rheumatic drugs (DMARDs) have similar efficacy to biological agents. A comprehensive literature search was carried out for randomised controlled trials investigating the effect of drug treatment in RA patients.

The authors conclude that DMARDs, glucocorticoid, biological treatments and combinations all reduce RA radiographic progression by 50–80%. One study found no difference between a biological agent and combination DMARD plus step-down glucocorticoid therapy, and they note that all other comparisons between biological agents and DMARD have been unbalanced using only one DMARD: further studies versus combinations are needed and should be demanded by regulatory authorities. The expensive biological agents should be reserved for patients for whom DMARDs in combination are ineffective.

1. Arthritis Rheum, published early online 17 June 2010