Combination therapy in rheumatoid arthritis: updated systematic review |
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Authors: | Verhoeven AC; Boers M; Tugwell P |
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Institution: | Department of Internal Medicine/Rheumatology, University Hospital, Maastricht, The Netherlands. |
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Abstract: | In a second update of a systematic review, many new developments in the
combined drug treatment of rheumatoid arthritis (RA) are highlighted. In
early RA patients, step-down bridge therapy that includes corticosteroids
leads to much enhanced efficacy at acceptable or low toxicity. The effects
on joint damage may be persistent, but the symptomatic effects are probably
dependent on continued corticosteroid dosing. In late patients, cyclosporin
improves a suboptimal clinical response to methotrexate, and the triple
combination of methotrexate, sulphasalazine and hydroxychloroquine appears
to be clinically better than the components. Other combinations are either
untested, tested at low sample size, or show negative interaction. In view
of the low volume of evidence, most studies need confirmation by
replication.
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