Table 36Early RA strategies: Functional capacity and health-related quality-of-life outcomes

StudyStudy Design
N
Duration
Study PopulationComparison (dose)Functional CapacityHealth-Related Quality of LifeQuality Rating
Two Oral DMARD+Corticosteroid vs. Oral DMARD
Boers et al., 1997;95 Landewe et al., 200296,
COBRA study
RCT
155 (148)
56 weeks (5-year followup)
Multicenter; early RA; mean disease duration 4 monthsSSZ (2g/day)+MTX (7.5 mg/day stopped after 40 weeks)+PNL (60 mg/day tapered over 28 weeks) vs. SSZMean change in HAQ: SSZ+MTX combination had greater improvements in functional capacity at 28 weeks (mean change in HAQ −1.1 vs. −0.6; P<0.0001) but difference not significant at 56 weeks (−0.8 vs. −0.6; P<0.06)NRGood
Two Oral DMARD+Corticosteroid vs. Oral DMARD
Mottonen et al., 1999;97 Korpela et al., 2004;98 Puolakka et al., 2004202,
FIN-RACo study
RCT
199
24 months (5-year followup)
Multicenter; early RA; mean disease duration 7.3 to 8.6 monthsMTX (7.5 to 10 mg/week)+HCQ (300 mg/day)+SSZ (2g/day)+PNL (5 to 10 mg/day) vs. DMARD (SSZ could be changed to MTX or 3rd DMARD) ± PNLLess work disability for combination group than monotherapy group (median 12.4 days per patient-observation year vs. 32.2; P=0.008)NRFair
Other Combination Strategies
Goekoop-Ruiterman et al., 2005;100 *Allaart et al., 2006;101 Goekoop-Ruiterman et al., 2007;102 van der Kooij et al., 2009;103 van der Kooij et al., 2009196
BeSt study
RCT
508
12 months
2 years
4 years
Multicenter; early RA; median duration between diagnosis and inclusion 2 weeks (IQR 1 to 5), median duration of symptoms 23 weeks (IQR 14 to 53)DAS-driven treatment;
1: sequential monotherapy starting with MTX (15 mg/week) vs. 2: step-up combination therapy (MTX, then SSZ, then HCQ, then PRED) vs. 3: combination with tapered high-dose PRED (60 mg/d to 7.5 mg/d) vs. 4: combination (MTX 25 to 30 mg/week) with INF (3 mg/kg every 8 weeks, per DAS, could be titrated to 10 mg/kg)
All groups improved; greater improvement for groups 3 and 4 than groups 1 or 2 at 3 months (improvement in D-HAQ for strategies 1 through 4: 0.4 vs. 0.4 vs. 0.8 vs. 0.8); better functional ability after 12 months for patients in group 3 or 4 than in group 1 (improvement in mean D-HAQ scores for strategies 1 through 4 were 0.7, 0.7, 0.9, and 0.9, respectively;
P<0.05 for 1 vs. 3 and 4, NS for other comparisons); No difference between groups at 24 months (0.7, 0.8, 0.9, and 0.9; P=0.26); improvements were maintained at 4 years, with no significant differences between groups (0.8, 0.7, 0.8, 0.8; P=0.64)
SF-36 PCS: Greater improvement at 3 months and 6 months for groups 3 and 4 than groups 1 and 2 (P<0.001); no difference at 1 and 2 years (P=0.10 and 0.95, respectively) difference
SF-36 MCS: No differences between groups at 3 months, 6 months, 1 year, or 2 years (P=0.22, 0.17, 0.83, 0.97, respectively)
Good
*

New study added since last review.

BeST = Dutch acronym for Behandel Sstrategieen; COBRA = Combinatietherapie Bij Reumatoide Artritis; DAS = disease activity score; D-HAQ = Health Assessment Questionnaire – Disability Index; DMARD = disease modifying antirheumatic drug; ERA = early rheumatoid arthritis; FIN-RACo = Finnish Rheumatoid Arthritis Combination Therapy; g/day = gram per day; HAQ = Health Assessment Questionnaire; HCQ = hydroxychloroquine; INF = infliximab; MCS = mental component score; mg/d = milligram per day; MTX = methotrexate; NR = not reported; NS = not significant; PCS = physical component score; PNL = prednisolone; PRED = prednisone; RA = rheumatoid arthritis; RCT = randomized controlled trial; SF-36 = Medical Outcomes Test, Short Form 36; SSZ = sulfasalazine

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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