Methotrexate triple combination therapy effective in rheumatoid arthritis
Methotrexate is one of the most effective and widely used medications for treating rheumatoid arthritis. It is a leader in a class of drugs known as DMARDs (disease-modifying anti-rheumatic drugs) which works to slow the progression of joint damage from the disease.
According to a Cochrane network systematic review and network meta-analysis of 158 trials with more than 37000 patients with rheumatoid arthritis, "Triple therapy" (methotrexate + sulfasalazine + hydroxychloroquine) was statistically superior to oral methotrexate for ACR50 response, in both methotrexates naive and methotrexate inadequate response populations and not statistically different from methotrexate plus biologic therapy for controlling disease activity.
For this analysis, data was collected and analyzed from randomized or quasi-randomized trials and compared methotrexate with any other DMARD or combination of DMARDs. A statistically significant benefit for other conventional synthetic DMARD combinations compared with oral methotrexate was also observed, but only after an inadequate response to methotrexate, and the magnitude of effect or quality of evidence was graded lower than for triple therapy.
The cost of triple therapy is 10-20 times which is less than biologic therapy, but is not currently recommended strongly by international guidelines. Therefore, these findings support therapeutic trial of triple therapy and with respect to clinical benefit, this therapy should be taken as an effective and low cost treatment option either as initial treatment or as a step-up treatment in patients who show inadequate response to methotrexate alone.