Patients with early rheumatoid arthritis stick with and tolerate triple DMARD therapy reasonably well in real-life practice, a new Australian study shows.

The results also showed that treating to the target of remission or low disease activity is more important than the number of DMARDs continued, said the Queensland researchers led by Professor Ranjeny Thomas.

In the observational study, 181 patients with new-onset RA referred to an Early Arthritis Clinic (EAC) were offered triple therapy (methotrexate, sulfasalazine and hydroxychloroquine) at diagnosis, with options to step-up treatment, including leflunomide or a biologic agent, with remission as the target.

Results showed that the median duration of continuous triple therapy was 39 weeks, and when a switch to a three-drug combination including leflunomide was made, the median duration of therapy increased to 70 weeks.

Around one third of patients starting triple therapy were intolerant of at least one drug. Sulfasalazine was the most toxic of the three drugs, accounting for almost half of initial drug withdrawals for an adverse event.

A similar rate of remission was achieved regardless of whether or not patients continued on triple therapy, with 43% of continuers and 41% of non-continuers in remission at 12 months.

Professor Ranjeny Thomas, one of the researchers from the University of Queensland Diamantina Institute in Brisbane, says this highlights that tight control, or treating to remission or low disease activity, is the most important thing and not trying to continue patients on triple therapy at all costs.

She says the new research provides useful real-life information on the longer-term use of triple therapy initiated after RA diagnosis in an Australian setting.

“Our practice is to use triple therapy, so we really wanted to illustrate that it was effective in getting people into remission or low disease activity, and that it had relatively low toxicity, bearing in mind that half of the patients will stop sulfasalazine,” she told the limbic.