Abstract
Objective: To confirm the efficacy of combination therapy with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in patients with rheumatoid arthritis (RA) in our institute.
Methods: From medical records, csDMARD use in 797 patients with RA was analysed retrospectively
Results: Forty-three (5.1%) out of 797 patients were treated with combination therapy at the time of the study. Twenty, eight and 15 patients were either in remission, had low disease activity or had moderate disease activity, respectively. Sixty-three combination therapy cases were discontinued for 54 (6.8%) patients because three were in remission, 49 had insufficient response, eight experienced adverse effects, and three cases were pregnant. Out of the 49 cases with an insufficient response, 18 cases (37%) started treatment with biologics. The most frequent combination of csDMARDs was methotrexate (MTX) plus tacrolimus (TAC) and 18 (56.3%) out of 32 cases continued the MTX-TAC combination therapy.
Discussion: According to a literature review, most csDMARD combinations include hydroxychloroquine that is unavailable in Japan, and the maximum doses of MTX and salazosulfapyridine are higher than those permitted in Japan under domestic regulations. In the study of the MTX-TAC combination the therapy could be continued with a lower-dose of additive TAC.
Conclusion: Considering csDMARDs and their dosages currently available in Japan, only few evidence based combination therapies with csDMARDs have been adopted. Sufficient doses of csDMARDs should be used to obtain the maximum benefit from the combination therapies. In this retrospective analysis, MTX and low-dose TAC appears to be a potent combination for the treatment of RA.
