“Triple Therapy” Effective Against RA


Among people with rheumatoid arthritis (RA) and an inadequate response to methotrexate, treatment with the relatively inexpensive “triple therapy” (sulfasalazine, hydroxychloroquine, and methotrexate) was as effective as treatment with EnbrelÒ (etanercept) and methotrexate. These results were published in the New England Journal of Medicine.

Biologic drugs such as Enbrel represent an important advance in the treatment of RA. These drugs are often used for people who continue to have active RA in spite of treatment with conventional drugs such as methotrexate.

Because the biologic drugs tend to be more expensive than conventional disease-modifying antirheumatic drugs (DMARDs), it’s important to determine when they should be used. To compare Enbrel with a combination of conventional DMARDs, researchers conducted a clinical trial among 353 patients who had had an inadequate response to methotrexate. Study participants were treated with either triple therapy (the combination of conventional drugs) or Enbrel plus methotrexate.

The primary outcome of interest was RA disease activity as assessed by the DAS28 score. Patients who did not improve after six months were switched to the other treatment.

  • Patients in both treatment groups improved significantly during the first six months. 27% of patients in each group switched treatment due to lack of efficacy of the initial treatment.
  • The improvement in the DAS28 score after 48 weeks was similar in the two treatment groups.

These results suggest that both triple therapy and Enbrel plus methotrexate provide effective treatment for RA patients who have had an inadequate response to methotrexate. Starting with the less expensive option and switching treatment as necessary may save money without reducing treatment effectiveness.

Reference: O’Dell JR, Mikuls TR, Taylor TH et al. Therapies for active rheumatoid arthritis after methotrexate failure. New England Journal of Medicine. Early online publication June 11, 2013.


Rheumatoid Arthritis