Lower Doses of Rheumatoid Arthritis Meds May Work for Some
Researchers find many patients with early-stage disease stay in remission with less medication
THURSDAY, Nov. 6, 2014 (HealthDay News) -- Some patients in the early stages of rheumatoid arthritis may be able to have their medication doses safely lowered once their symptoms are well under control, according to a study published in the Nov. 6 issue of the New England Journal of Medicine.
Paul Emery, M.D., of the University of Leeds in the United Kingdom, and colleagues evaluated data for a group of patients who were all in the early stages of rheumatoid arthritis. Initially, 222 patients spent a year on weekly injections of etanercept (Enbrel), along with oral methotrexate. Of that group, 193 saw their symptoms go into remission by the one-year mark, and they entered the double-blind phase of the study. At that point, the authors randomly assigned them to one of three groups: reduced-dose etanercept plus methotrexate (combination-therapy group), methotrexate alone, or placebo.
After about eight months, the investigators found that a significantly higher proportion (63 percent) of patients in the combination-therapy group were still in remission. That compared with 40 percent of those on methotrexate alone, and 23 percent of those receiving placebo. In a final step, the researchers had patients who were still in remission stop all treatment. About six months later, some patients remained in remission, including 44 percent of those who had received combination therapy with reduced-dose etanercept and methotrexate, 29 percent of those who had received methotrexate alone, and 23 percent of those who had received placebo.
"This doesn't give us enough guidance to make broad-based recommendations," Diane Horowitz, M.D., of North Shore University Hospital in Manhasset, N.Y., who reviewed the study, told HealthDay. "I'm not saying we should never lower patients' doses," she added. And in certain cases -- such as when a patient can't tolerate the medications' side effects -- the current findings offer useful information. But, she said, longer-term studies are needed before any general recommendations could be made.
Several authors disclosed financial ties to Pfizer, which manufactures etanercept and funded the study.