Triple DMARD Therapy Bested by Biologics in Swedish Registry Save

The Swedish Register compared outcomes of 1502 rheumatoid arthritis (RA) patients initiating either biologics plus methotrexate (MTX) or triple therapy (MTX plus sulfasalazine plus hydroxychloroquine/chloroquine) and showed similar rates of sustained remission.

Sustained remission was defined as a Disease Activity Score in 28 joints (DAS28) of <2.6 for ≥6 months (short-term sustained remission) or for ≥24 months (long-term sustained remission). Outcomes were assessed at year, and at 2 years. 

Among 1,502 RA patients, after an inadequate response to MTX monotherapy, 1,155 initiated biologic therapy and 347 started triple therapy. Below are the adjusted odds ratios (ORs) of short-term and long-term remission.

Several caveats from this study:

• There were more treatment discontinuations before 1 year and before 2 years in the triple therapy group compared to those receiving biologic therapy
• Triple therapy patients generally had disease characteristics suggestive of milder disease than patients receiving biologic therapy. 
• A lower proportion of patients starting triple therapy in our study received glucocorticoids at treatment start
• The number achieving long-term sustained remission at 1 year and 2 years among all patients was relatively low (8–12%)

In this observational cohort analysis, biologic therapy was more effective for remaining on therapy and had a greater likelihood of reaching sustained remission. Nonetheless, certain RA patients, especially those who continue triple therapy, demonstrate sustained remission rates equal to those who stayed on biologics.