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Rheumatoid management hinges on choosing your best therapies first. Landmark studies, such as the TEAR, SWEFOT, and RACAT trials have questioned the comparative efficacy of initial triple DMARD therapy (methotrexate, sulfasalazine,hydroxychloroquine) and combination therapy with methotrexate (MTX) plus etanercept (ETN). While the efficacy statistics suggest initial triple DMARD therapy is more cost effective and equally beneficial to the biologic comparator, these data have not assessed adherence to such therapies as an outcome measure.
Bonafede and coworkers have analyzed commercial claims data and compared 3,724 RA patients who were treated with the combinatoin of ETN-MTX and compared them to 818 triple-DMARD therapy patients. Adherence was assessed as >80% coverage for a particular regimen and persistence was defined as no >45 day gap in treatment and no addition or switch to other DMARDs. At 1 year, 27.9% on ETN-MTX and 18.2% on triple-DMARD therapy were adherent (P < 0.0001) and 29.4% on ETN-MTX and 23.2% on triple DMARD therapy were persistent (P < 0.001). The adjusted odds ratio of being adherent favored the combination of ETN-MTX (OR 1.79; 95% CI 1.47, 2.17) compared with patients on triple-DMARD therapy.