Therapies for Active Rheumatoid Arthritis after Methotrexate Failure

Abstract

Rheumatoid arthritis (RA) is a common autoimmune inflammatory arthritis with a one percent prevalence worldwide. Left untreated, it leads to chronic progressive joint disease. Joint damage and erosions develop within two years of disease onset in a majority of patients, and early control of disease activity has been shown to improve long-term outcomes. Methotrexate has long been the staple of RA treatment and has been proven effective as a disease modifying agent in RA, as well as proven to decrease mortality in RA patients. While about twenty-five percent of patients achieve good response with methotrexate alone, the rest require additional or other therapy. This review discusses some of the sentinel trials looking at how best to treat RA patients who have failed methotrexate therapy. In particular, it focuses on the trials comparing triple therapy to biologics. It also addresses the tolerability and cost associated with some of these therapies. The next decade will bring more treatment options, and hopefully, more answers with regards to how to provide the best value therapy for each individual patient.