2016 Volume 28 Issue 3 Pages 197-203
[Objective] We have retrospectively compared a triple therapy consisting of a combination of disease-modifying anti-rheumatic drugs with biologic agents for patients with established rheumatoid arthritis (RA) who had not improved despite treatment with methotrexate (MTX).
[Materials and Methods] We classified patients in 2 groups, one group added Tacrolimus (TAC) and Mizoribine (MZR) (S group) and the other added TNF inhibitor (B group). DAS28CRP, modified total sharp score and ARASHI change score which is scoring system of large joint destruction were evaluated and compared between both groups. We also estimated and compared the survival rate and the reasons of discontinuation of each group.
[Results] There was no significant difference in baseline characteristics between two groups. Both groups showed significant improvement of disease activity. The improvement rate of DAS28CRP in the B group was higher than that in the S group at 1 month after the treatment. However, no significant difference was observed between two groups at 3 months after treatment and it continued during 2 years. There was no significant difference in radiographic progression of large joints. However the progression of small joint damage was more severe than that in S group. Sixteen percent in S group and 4.3% in B group had discontinued because of adverse events.
[Conclusion] Triple therapy using TAC, MZR and MTX had advantage in medical exponses compared with biologics for established RA patients. However the triple therapy might be inferior to biologics in inhibiting small joint destruction and safety, we should be careful about them.
