[Combination therapy using methotrexate with DMARDs or biologics--current status].
Methotrexate (MTX) is the most frequently used drug in combination treatment with disease-modifying antirheumatic drugs (DMARDs) and biologics in rheumatoid arthritis. DMARD combinations are usually the second step after unsuccessful MTX monotherapy. Evidence-based combinations of MTX+leflunomide, MTX+cyclosporine and triple combination MTX+sulphasalazine+hydroxychloroquine (complemented by glucocorticoids) showed the best results.In the case of insufficient response to the DMARD combination, MTX should be used in combination with a biologic. To date, the most frequent biologic treatment is with TNF inhibitors, but studies have shown that all biologics (with the exception of Anakinra) have comparable success rates. The combination of MTX plus abatacept, MTX plus rituximab and MTX plus tocilizumab are very promising, both clinically and in terms of blocking radiological progression. The efficacy of biological therapy is generally better using MTX combination than monotherapy.The safety of MTX combination treatment with DMARDs is not significantly lower than that of the individual substances; therefore, the required safety controls are also the same.
Rheumatologisches Praxiszentrum St. Bonifatius, St. Bonifatius Strasse 5, Munich, Germany. klaus.krueger@med.uni-muenchen.de
K
K
Krüger
D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage*; D004338:Drug Combinations; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D001688:Biological Products; D004338:Drug Combinations; D008727:Methotrexate
Br J Rheumatol. 1997 Oct;36(10):1082-8
9374925
Arthritis Rheum. 2009 Aug;60(8):2272-83
19644849
Ann Intern Med. 2002 Nov 5;137(9):726-33
12416946
Ann Rheum Dis. 2010 Oct;69(10):1789-95
20444751
Ann Rheum Dis. 2010 Jun;69(6):1129-35
20444749
Arthritis Rheum. 1992 Aug;35(8):849-56
1642652
Arthritis Rheum. 2002 May;46(5):1164-70
12115219
Arthritis Rheum. 2006 May;54(5):1401-9
16645967
Lancet. 1999 May 8;353(9164):1568-73
10334255
Rheumatology (Oxford). 2009 Jul;48(7):828-33
19458163
Ann Intern Med. 2006 Jun 20;144(12):865-76
16785475
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S179-85
14969073
Lancet. 2009 Aug 8;374(9688):459-66
19665644
Scand J Rheumatol. 2011 Jan;40(1):16-21
20726683
N Engl J Med. 1985 Mar 28;312(13):818-22
3883172
Lancet. 2008 Mar 22;371(9617):987-97
18358926
Ann Rheum Dis. 2011 Jan;70(1):39-46
20937671
Rheumatology (Oxford). 2010 Jan;49(1):91-8
19917618
Lancet. 2008 Aug 2;372(9636):375-82
18635256
Ann Rheum Dis. 2009 Dec;68(12):1870-7
19124524
Ann Rheum Dis. 2009 Jul;68(7):1086-93
19033291
Ann Rheum Dis. 2009 Jul;68(7):1105-12
19054823
Arthritis Rheum. 2005 May;52(5):1360-70
15880810
Ann Rheum Dis. 1999 Apr;58(4):220-5
10364900
J Rheumatol. 2010 Nov;37(11):2237-46
20889601
Ann Rheum Dis. 2010 Oct;69(10):1803-8
20447953
N Engl J Med. 1996 May 16;334(20):1287-91
8609945
Arthritis Rheum. 2004 Nov;50(11):3432-43
15529377
Ann Rheum Dis. 2007 Feb;66(2):235-41
16926184
Ann Rheum Dis. 2010 Jul;69(7):1298-304
20421343
Rheumatology (Oxford). 2010 Jul;49(7):1267-71
20008093
Arthritis Rheum. 2006 Jan;54(1):26-37
16385520
Arthritis Rheum. 2006 Sep;54(9):2793-806
16947627
Lancet. 2004 Feb 28;363(9410):675-81
15001324
Arthritis Rheum. 2008 Nov;58(11):3319-29
18975346
N Engl J Med. 1995 Jul 20;333(3):137-41
7791814
Lancet. 1997 Aug 2;350(9074):309-18
9251634
Nat Clin Pract Rheumatol. 2007 Aug;3(8):450-8; quiz, following 478
17664952
Lancet. 1999 Dec 4;354(9194):1932-9
10622295
Rheumatology (Oxford). 2009 Nov;48(11):1429-34
19741011
Ann Rheum Dis. 2010 Jun;69(6):964-75
20444750
Ann Rheum Dis. 2008 May;67(5):656-63
17768173
Ann Rheum Dis. 2010 May;69(5):807-12
19451137