He also highlighted two other studies in adults regarding the treatment of active rheumatoid arthritis (RA), each of which offers important data on challenging questions on the management of RA patients. He noted results of the study by O’Dell and colleagues that showed for the first time the noninferiority of triple therapy compared to etanercept plus methotrexate (MTX) for patients with active RA who don’t respond to MTX alone.2
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Explore This IssueDecember 2013
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According to Chester V. Oddis, MD, professor of medicine and associate director of the rheumatology fellowship training program at the Arthritis Institute in Pittsburgh, who moderated the session, this study offers convincing data that triple therapy produces similar outcomes to biologics, in particular, anti–tumor necrosis factor therapy. “Not only is this an important area from a practice perspective, but it is very important economically, and when payers see this and react to it, then this could greatly affect our choice of treatments for RA,” he said.
Another clinical question that is on the minds of many rheumatologists and was addressed in a 2013 published study, said Dr. Wofsy, is whether there is a window of opportunity in early poor prognosis RA that warrants immediate combination therapy. He briefly described a post-hoc analysis of the TEAR trial by O’Dell, Moreland, and colleagues that looked at this a question by randomizing 755 patients with active early RA to immediate combination therapy, MTX plus step up to combination therapy at 24 weeks, or MTX monotherapy.3 At 102 weeks, the study showed comparable clinical and radiographic outcomes between patients treated with initial MTX monotherapy with the option to step up to combination therapy and those treated with initial combination therapy.
Finally, he briefly described a longer follow-up study by Specks and colleagues on remission-inducing regimens for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis.4 The study included 197 patients with severe, organ-threatening ANCA-associated vasculitis randomized to rituximab followed by placebo or cyclophosphamide followed by azathioprine. A 2010 report at six months showed that rituximab was noninferior at six months and superior for relapsing disease. In this updated study, rituximab continued to show noninferiority and superiority at 12 and 18 months. Dr. Wofsy emphasized the importance of the long-term efficacy and sustained response with rituximab shown in the study, as well as the great collaboration among researchers that addressed this challenging problem.
Along with highlighting some of the key studies in adults, he briefly summarized study data on five drugs with new indications—three of which are for pediatrics (See Table 1).