According to the US Agency for Healthcare Research and Quality (AHRQ), combining a well-known, inexpensive synthetic medicine with one of the six biological medicines works best to reduce joint swelling and tenderness in rheumatoid arthritis.
The review compared synthetic disease-modifying anti-rheumatic drugs (DMARDs): hydroxychloroquine, leflunomide, methotrexate and sulfasalazine; biological DMARDs: abatacept, adalimumab, anakinra, etanercept, infliximab and rituximab; and corticosteroids such as prednisone. The main findings:
- Prednisone combined with a synthetic DMARD gave better results than a synthetic DMARD alone.
- There were no important clinical differences between methotrexate and leflunomide or sulfasalazine.
- In early rheumatoid arthritis, methotrexate plus sulfasalazine was no better than either alone.
- There wasn't enough evidence to say whether combining two biological DMARDs is better than one alone.
- About 17 in 1,000 people taking biological DMARDs for 3–12 months developed serious infections, and combining two biologicals increased the risk.
- Injection-site pain was more common with anakinra (67%) than with etanercept (22%) or adalimumab (18%).
Long-term studies are needed, including in different groups of patients, and to find out whether starting biological DMARDs early is better for long-term treatment.
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