Table 12Radiographic joint damage in oral DMARD combinations versus monotherapy combinations with or without corticosteroid studies

StudyStudy Design
Population with Early RA (< 3 years)Comparison (dose)Radiographic Outcomes
Sulfasalazine+MTX vs. Sulfasalazine or MTX
Capell et al., 200659RCT
165 (Phase 1 run-in: 687)
6 months (18 months for those with DAS ≥2.4 at 6 months)
Yes (70% 1 year or less)SSZ (≤4 g/day)+MTX (≤25 mg/week) vs. SSZ (≤4 g/day) vs. MTX (≤25 mg/week)No significant difference in total Sharp score (data NR)
Dougados et al., 1999;57 Maillefert et al., 2003111RCT
209 (146)
52 weeks (5-year followup)
YesSSZ (2 to 3 g/day)+ MTX (7.5 to 15 mg/week) vs. SSZ (2 to 3 g/day) vs. MTX (7.5 to 15 mg/week)5-year mean modified Sharp/van der Heijde score change: 8.5 vs. 7.5; P=0.7
Oral DMARD+Corticosteroid vs. Oral DMaRD
*Choy, et al., 200864RCT
2 years
YesMTX (≤15 mg/week)+PNL (60 mg/day stepped down and stopped at 34 weeks) vs. MTXLarsen score change 7.41 vs. 4.70; P=0.008
Svensson et al., 200565Open-label RCT trial
2 years
YesDMARD (SSZ or MTX, dosages NR)+PNL (7.5 mg/day) vs. DMARDMedian modified Sharp/van der Heijde score change: 1.8 vs. 3.5; P=0.019
Erosion score median change: 0.5 vs. 1.25; P=0.007
Joint space narrowing score median change: 1.0 vs. 2.0; P=0.08

New study added since last review.

ACR = American College of Rheumatology; DAS = disease activity score, DMARD = disease-modifying antirheumatic drug; g = gram; HQC = hydroxychloroquine; LEF = leflunomide; MTX = methotrexate; mg = milligram; NR = not reported; NS = not significant; PRED = prednisone; RA = rheumatoid arthritis; RCT = randomized controlled trial; SSZ = sulfasalazine; vs. = versus

From: Results

Cover of Drug Therapy for Rheumatoid Arthritis in Adults: An Update
Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet].
Comparative Effectiveness Reviews, No. 55.
Donahue KE, Jonas DE, Hansen RA, et al.

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