Limited efficacy of conventional DMARDs after initial methotrexate failure in patients with recent onset rheumatoid arthritis treated according to the disease activity score

• DOI: 10.1136/ard.2006.066662
• Publication Date: 2007-02-10T01:29:09Z
• Authors: Sjoerd M van der ...; Jeska K de Vries-...; Yvonne P M Goekoo...; Derkjen van Zeben; Pit J S M Kerstens; Andreas H Gerards; Johannes H L M va...; Johanna M W Hazes; Ferdinand C Breed...; Cornelia F Allaart; Ben A C Dijkmans
• Keywords: Male; Anti-Inflammatory Agents; EMC MUSC-01-31-01; Kaplan-Meier Estimate; Drug Administration Schedule; Arthritis, Rheumatoid; 03 medical and health sciences; 0302 clinical medicine; Clinical Protocols; Humans; Arthrography; Antibodies, Monoclonal; Isoxazoles; Middle Aged; Infliximab; 3. Good health; Sulfasalazine; Methotrexate; Antirheumatic Agents; Prednisone; Drug Therapy, Combination; Female; Leflunomide; Hydroxychloroquine

<h3>Objectives:</h3> To determine the efficacy of subsequent disease modifying antirheumatic drug (DMARD) therapies after initial methotrexate (MTX) failure in patients with recent onset rheumatoid arthritis (RA), treated according to DAS for 2 years. <h3>Methods:</h3> In groups 1 and BeSt study, 244 RA were initially MTX 15–25 mg/week. Patients who discontinued because insufficient clinical response (disease activity score, &gt;2.4) or toxicity classified as "MTX failures." group 1, these switched sulfasalazine (SSA), then leflunomide finally + infliximab (IFX). 2, failures" added SSA MTX, hydroxychloroquine (HCQ), prednisone, eventually IFX. successes" achieved a ⩽2.4 years while still on monotherapy. Total Sharp/van der Heijde score (TSS) progression from 0–2 was assessed versus successes." <h3>Results:</h3> After years, 162/244 (66%) had toxicity. Of these, 78% also failed (adding switching), 87% subsequently (in 1), 64% HCQ 2). 34 48 (71%) successfully regardless "success" DMARDs, " median TSS 3 units (mean 9) unit 3) (p = 0.007). <h3>Conclusion:</h3> treatment conventional DMARDs is unlikely result allows joint damage.