State-of-the-art combination therapy in 1999

Over the past 5 years, the shift in the paradigm of treatment for rheumatoid arthritis involves increasing emphasis on combination therapy. Because rheumatoid arthritis is a lifelong disease process, the results of longer-term studies are essential for ultimately defining the most effective therapies. Differences in drug doses and dose escalation, patient populations, and trial design can make comparisons among currently available studies difficult, particularly those involving combination therapy. In a 2- year study triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine was shown to be superior to single-drug therapy with methotrexate 17.5 mg/week. Another study showed that patients treated with prednisolone, sulfasalazine, and methotrexate responded better than patients treated with sulfasalazine alone, even when the prednisolone and methotrexate doses were tapered. Because of the potential for genetic variations to cause differing responses to drugs, pharmacogenetics may be used in the future to select patients for different therapies.