Saunders SA et al. – Highly effective control of disease activity can be achieved using conventional DMARDs as part of an intensive disease management strategy. Methods
A study to test the hypothesis that early parallel triple therapy achieves better outcomes than step-up therapy within an intensive disease management regimen
96 early RA pts were randomized to receive step-up therapy starting with sulfasalazine (SSZ) for 3 mos
After 3 mos, methotrexate [MTX] was added, and when the maximum tolerated dosage of MTX was reached, hydroxychloroquine (HCQ) was added or parallel triple therapy (SSZ/MTX/HCQ)
All pts were assessed/month x12 mos
If their DAS28 was >=3.2, the dosage of DMARDs was increased according to protocol, and swollen joints were injected with triamcinolone acetonide (max dosage 80 mg/mo)
Assessments were performed every 3 mos
The primary outcome measure was the mean decrease in the DAS28 score at 12 mos
Results
Both groups showed substantial improvements in disease activity and functional outcome
At 12 mos, the mean decrease in the DAS28 score was -4.0 (step-up) vs -3.3 (triple therapy)
No significant differences in the % of pts with DAS28 remission, DAS28 good response, ACR20, ACR50, or ACR70 responses were seen
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