Combination therapy in rheumatoid arthritis: updated systematic review

In a second update of a systematic review, many new developments in thecombined drug treatment of rheumatoid arthritis (RA) are highlighted. Inearly RA patients, step-down bridge therapy that includes corticosteroidsleads to much enhanced efficacy at acceptable or low toxicity. The effectson joint damage may be persistent, but the symptomatic effects are probablydependent on continued corticosteroid dosing. In late patients, cyclosporinimproves a suboptimal clinical response to methotrexate, and the triplecombination of methotrexate, sulphasalazine and hydroxychloroquine appearsto be clinically better than the components. Other combinations are eitheruntested, tested at low sample size, or show negative interaction. In viewof the low volume of evidence, most studies need confirmation byreplication.