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A new report funded by the Agency for Healthcare Research and Quality (AHRQ), compares the benefits and harms of 3 classes of medications:

  1. Synthetic disease-modifying antirheumatic drugs (DMARDs), which includes hydroxychloroquine, leflunomide, methotrexate, and sulfasalzine.
  2. Biologic DMARDs, which inclues abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab.
  3. And corticosteroids, including drugs such as predinsone.

The report concludes that combining methotrexate, a synthetic DMARD, with one of the biologic DMARDs works better than using methotrexate or biologic DMARD alone.

Also, the report found that methotrexate works as effectively as the biologic DMARDs adalimumab and etanercept for patients who have early rheumatoid arthritis. However, adalimumab and etanercept show better short-term results as measured by X-rays of joints.

The report also empasizes that biologic DMARDs and methotrexate increase the risk of serious infection, including a reoccurence of tuberculosis.

Among other findings in the report:

  • Combining prednisone with the synthetic DMARD hydroxychloroquine, methotrexate or sulfasalazine works better than using only a synthetic DMARD to reduce joint swelling and tenderness and to improve function.
  • No meaningful clinical differences can be found between methotrexate and either leflunomide or sulfasalazine.
  • Combining the synthetic DMARDs methotrexate and sulfasalazine is no more effective than using just one of the medications for patients with early rheumatoid arthritis.
  • Not enough evidence exists to determine whether combining two biologic DMARDs is more effective than using one biologic DMARD.
  • About 17 of every 1,000 people taking a biologic DMARD for 3 to 12 months have a serious infection. Combining two biologic DMARDs can increase the risk.
  • Among biologic DMARDs, rates of painful injection site reactions are more common for anakinra (67 percent) than for etanercept (22 percent) or adalimumab (18 percent).
  • More long-term research is needed on rheumatoid arthritis medications, including how the outcomes of these drugs vary among patients with different health conditions and demographic characteristics. More comparative studies on various combinations of drugs are critical. Also important is investigating whether taking the medications earlier (especially biologic DMARDs) is better for long-term outcomes.

Additional information, including full reports and plain-language summary guides, can be found at http://www.effectivehealthcare.ahrq.gov.

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