The usefulness of a new triple combination treatment utilizing methotrexate, salazosulfapyridine, and bucillamine in rheumatoid arthritis

Matsuno, Hiroaki; Okada, Masato; Sakai, Yoshitada; Abe, Chiyuki; Katayama, Kou; Sagawa, Akira; Yamasaki, K; Kondo, Masakazu; Funahashi, Koji; Matsubara, Tsukasa

doi:10.3109/14397595.2015.1059984

Cited by 8 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…EULAR recommendations are thought to have a sound therapeutic basis for abiding strictly to the T2T strategy. Indeed, recent studies have reported excellent results of triple DMARD therapy that is equivalent to that seen with bDMARDs [De Jong et al 2014;Karlsson et al 2013;Moreland et al 2012;O'Dell et al 2013;Matsuno et al 2016]. However, evaluation of the results of triple therapy must be cautious because the prevalence of discontinuation of treatment is higher in triple therapy than combination therapy of MTX plus bDMARDs according to Moreland and colleagues (37% versus 30%) [Moreland et al 2012] and Karlsson and colleagues (26% versus 10%) [Karlsson et al 2013].…”

Section: Which Combination Therapies Are Available?mentioning

confidence: 99%

Combination therapy with biologic agents in rheumatic diseases: current and future prospects

Inui

Koike

2016

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

Strategies in rheumatoid arthritis (RA) based on 'treat to target' aim to control disease activity, minimize structural damage, and promote longer life. Several disease-modifying antirheumatic drugs (DMARDs) have been shown to be effective including biological DMARDs (bDMARDs). Treatment guidelines and recommendations for RA have also been published. According to those guidelines, conventional synthetic DMARDs (csDMARDs), as monotherapy or combination therapy, should be used in DMARD-naïve patients, irrespective of the addition of glucocorticoids (GCs). Combination therapies with bDMARDs are also essential for conducting treatment strategies for RA, because in every recommendation or guideline for the management of RA, combination therapies of csDMARDs with bDMARDs are recommended for RA patients with moderate or high disease activity after failure of csDMARD treatment. bDMARDs are more efficacious if used concomitantly with methotrexate (MTX) than with MTX monotherapy or bDMARD monotherapy. Thus, retention has been reported to be longer when combined with MTX. The superior efficacy of combination therapy compared with MTX monotherapy or bDMARD monotherapy could be because: (1) it could help to minimize MTX toxicity by reducing the dose of MTX, thus retention rate of the same therapeutic regimen would become high; (2) anti-bDMARD antibodies are observed at lower concentrations when using MTX concomitantly, so less clearance of bDMARDs less formation of bDMARD and an anti-bDMARD immune complex; (3) of the additive effects of MTX to bDMARD, especially the combination of tumor necrosis factor inhibitors (TNFis) with MTX. Hence, evidence suggests that combination therapy with bDMARDs is more efficacious than monotherapy using a csDMARD or bDMARD, and that MTX is the best drug for this purpose (if MTX is not contraindicated). Finding the most effective drug regimen at the lowest cost will be the aim of RA treatment in the future.

show abstract

Section: Which Combination Therapies Are Available?mentioning

confidence: 99%

Combination therapy with biologic agents in rheumatic diseases: current and future prospects

Inui

Koike

2016

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

show abstract

“…Six of the eight patients without flare received intensified csDMARD therapy. The usefulness of triple-combination therapy for inducing remission has been previously reported ( 11 , 12 ). Kurasawa et al reported the efficacy of adding another csDMARD to reduce the flare rate after the discontinuation of IFX ( 6 ).…”

Section: Discussionmentioning

confidence: 94%

Two-year Outcomes of Infliximab Discontinuation in Patients with Rheumatoid Arthritis: A Retrospective Analysis from a Single Center

et al. 2020

View full text Add to dashboard Cite

Objective To investigate the clinical outcomes of rheumatoid arthritis (RA) patients who discontinued infliximab (IFX) treatment at our hospital. Methods Among 249 patients receiving IFX from 2007 to 2015, we retrospectively investigated the clinical courses of 18 who discontinued IFX after achieving the 28-joint disease activity score based on the erythrocyte sedimentation (DAS28-ESR) clinical remission (CR) and whose clinical courses were available continuously for 96 weeks after discontinuation. Results At IFX introduction, the median age was 56.9 (range 36.1-72.4) years, and the disease duration was 5.2 (0.4-25.6) years. The median duration of maintaining either CR or a low disease activity (LDA) with IFX was 37.2 (4.0-91.4) months, and the total duration of IFX therapy was 45.8 (17.1-96.9) months. After discontinuation, 8 patients (44.4%) maintained CR/LDA for 96 weeks (no-flare group), and 10 (55.6%) experienced flares (DAS28-ESR≥3.2) within 96 weeks (flare group). In the no-flare group, six patients receiving intensified conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy to prevent flare ups simultaneously either with or immediately after discontinuing IFX. In the flare group, four patients received intensified csDMARD therapy. Six patients restarted biological DMARDs (bDMARDs), and all achieved CR again. Ultimately, 12 patients (66.7%) maintained a Bio-free disease control for 96 weeks. A comparison of the clinical backgrounds between the flare and no-flare groups showed no marked difference in their disease duration, IFX dosage, duration of maintaining CR with IFX, or concomitant csDMARDs use. Conclusion Irrespective of the RA disease duration, more than half of all patients maintained a Bio-free condition for 96 weeks. Continuing LDA with IFX for a sufficiently long period of time before discontinuation and preventive intensification of csDMARD therapy may help maintain a Bio-free condition.

show abstract

“…Since the effects of csDMARDs appear more slowly than those of MTX+TNF inhibitors, the clinical response of the triple therapy was comparable to that of MTX+TNF inhibitors, except for the fact that there were some differences in the degree of joint destruction (17, 18). It should be noted that the findings of O'Dell's and Matsuno's studies did not indicate that the effects of csDMARDs appear more slowly than those of MTX+TNF inhibitors (19, 20). In our study, we used ADA with MTX and increased the number of csDMARDs, with the aim of administering triple csDMARD therapy.…”

Section: Discussionmentioning

confidence: 92%

“…Another reason for the good results regarding the numbers of patients who could achieve a Bio-free condition in our study may be the use of csDMARDs other than MTX. There have been reports of triple therapy with csDMARDs, and the clinical results were as good as those obtained with MTX+TNF inhibitors (17-20). Since the effects of csDMARDs appear more slowly than those of MTX+TNF inhibitors, the clinical response of the triple therapy was comparable to that of MTX+TNF inhibitors, except for the fact that there were some differences in the degree of joint destruction (17, 18).…”

Section: Discussionmentioning

confidence: 94%

An Analysis of the Biological Disease-modifying Antirheumatic Drug-free Condition of Adalimumab-treated Rheumatoid Arthritis Patients

et al. 2019

View full text Add to dashboard Cite

Objectives The present study was performed with the aim of analyzing the biological disease-modifying antirheumatic drug (bDMARD)-free (Bio-free) condition of adalimumab (ADA)-treated rheumatoid arthritis (RA) patients in a real-world setting. Methods ADA was used in the treatment of 130 (male, n=21; female, n=109 females) RA patients. Among them, 26 patients (20.0%) discontinued ADA due to a good response. We analyzed 20 patients who were followed up for more than 6 months after the discontinuation of ADA. The Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and modified health assessment questionnaires (mHAQs) were evaluated. Results The mean age of the patients was 53.4±11.1 years. The mean disease duration was 4.5±4.3 years. Sixteen patients were bDMARD-naïve, while 4 switched from bDMARDs to ADA. At 6 months after the discontinuation ADA, 19 patients had achieved a clinical remission, and 1 had achieved a low disease activity. The Bio-free period was 26.4±15.5 months. The dose of prednisolone was significantly reduced from baseline (3.45±3.17 mg/day) at 6 months after the discontinuation of ADA (2.63±2.78 mg/day). The dose of methotrexate was unchanged. The number of conventional synthetic DMARDs (csDMARDs) was significantly increased (0.8±0.6 to 1.4±1.06). The mHAQ values were significantly ameliorated by ADA and remained good in patients with a Bio-free condition. A multivariate analysis showed that the dose of MTX was an important factor for achieving a Bio-free condition. Conclusions A sustainable Bio-free condition in a real clinical setting can be achieved and may be a suitable way of reducing medical costs. The dose of MTX and the additional administration of csDMARDs is therefore thought to be important for ensuring a good outcome in these patients.

show abstract

The usefulness of a new triple combination treatment utilizing methotrexate, salazosulfapyridine, and bucillamine in rheumatoid arthritis

Abstract: The triple DMARD combination therapy provided a new treatment option for those patients for whom treatment with biologics is difficult.

Cited by 8 publications

References 23 publications

Combination therapy with biologic agents in rheumatic diseases: current and future prospects

Combination therapy with biologic agents in rheumatic diseases: current and future prospects

Two-year Outcomes of Infliximab Discontinuation in Patients with Rheumatoid Arthritis: A Retrospective Analysis from a Single Center

An Analysis of the Biological Disease-modifying Antirheumatic Drug-free Condition of Adalimumab-treated Rheumatoid Arthritis Patients

Contact Info

Product

Resources

About