Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
“While both therapies we studied are effective treatments for early rheumatoid arthritis, there is a notable price difference between the two treatments. Biologic drug treatments are significantly more expensive than the alternative,” said Larry Moreland, M.D., lead investigator and chief of rheumatology at the University of Pittsburgh School of Medicine.
In the two-year study, initiated while Dr. Moreland was at the University of Alabama at Birmingham, researchers looked at the benefit of taking either a combination of three oral disease-modifying, anti-rheumatic drugs (DMARDs), or a combination of one DMARD and a biologic drug, also known as a TNF antagonist or anti-TNF therapy.
DMARDs, which for the purpose of this study included methotrexate, sufasalazine and hydroxychloroquine, are a class of drugs known to not only reduce inflammation and pain, but they also slow the overall progression of disease.
Biologic drugs are given by injection and lessen inflammation by interfering with biologic substances that cause or worsen the inflammatory process. For this study, researchers studied the effects of the biologic drug etanercept.
Researchers followed 755 participants who were diagnosed with early RA, randomly dividing them into four treatment groups. Two groups began with triple DMARD treatments, while the other two were treated with a combination therapy of methotrexate and etanercept. At the two-year mark, researchers found no difference in the average levels of DAS28, a measurement of swollen and tender joints, level of inflammation and patient reported pain, between patients randomized to etanercept or triple DMARD therapy.
“This study was the first to directly compare these two RA therapies, and data from this investigator-initiated study provides critical information for researchers. However, much more work is needed in order for physicians to be able to better prescribe the most effective therapies for individual patients. Specifically, this study did not examine data from patient x-rays, which could provide crucial future data for determining how each of these drug treatments affects the body,” Dr. Moreland said.
Co-authors of the study are James O’Dell, M.D., University of Nebraska Medical Center; Harold Paulus, M.D., UCLA School of Medicine; Jeffrey R. Curtis, M.D., M.P.H., S.L. Bridges Jr., M.D., Xiao Zhang, Ph.D., George Howard and Stacey S. Cofield, Ph.D., all from the University of Alabama at Birmingham.
Editor’s Notes: Dr. Moreland will present this research during the ACR Annual Scientific Meeting at the Pennsylvania Convention Center in Philadelphia at 11:45 a.m., Tuesday, Oct. 20. He will be available for media questions and briefing at 1:30 p.m., Sunday, Oct. 18 in the on-site press conference room, 109 A. For more information about the ACR’s annual meeting, see www.rheumatology.org/annual.