New Rheumatoid Arthritis Drug Combination Deemed Effective

Researchers find optimal combination and dosage for three common antirheumatic drugs.

A drug combination for the treatment of rheumatoid arthritis (RA) was found to be safe, effective, and inexpensive in a recent study.

Published recently in the Annals of Rheumatic Diseases, researchers sought to determine the optimal combination and dosage of commonly prescribed antirheumatic drugs methotrexate, sulfasalazine, and leflunomide in combination with glucocorticoids. The researchers divided 290 early RA patients into 3 treatment groups, with each receiving a different combination therapy.

The groups were dubbed COBRA Classic (methotrexate, sulfasalazine and a high first dose of glucocorticoids), COBRA Slim (methotrexate and a moderate dose of glucocorticoids) and COBRA Avant-Garde (methotrexate, leflunomide and a moderate dose of glucocorticoids). All three cohorts achieved a similarly high efficacy rate, with disease remission achieved in 7 of 10 patients per group after 16 weeks of treatment.

There was, however, a significant difference in terms of side effects.

The COBRA Slim treatment, in which patients received the least amount of medication, had half of the side effects as the two other groups but was found to be equally as effective. This strategy is also easier to implement in daily practice because it is less complicated, the researchers noted.

Treatment with methotrexate and a moderate dose of glucocorticoids can potentially lead to higher remission rates in the global early RA population, while possibly reducing the need for costly second-line antirheumatic treatments, the study noted. Additionally, the drug combination can treat up to 15 patients for the same price as one patient undergoing a year of treatment with a pricier biological drug.

"One surprising finding in the study was the high remission values recorded for all of the applied intensive treatment strategies, which were unprecedented internationally," researcher Diederik De Cock said in a press release. "Methotrexate is very affordable, as are steroids.”