title: Effectiveness of sulfasalazine and methotrexate in 1102 DMARD-naive patients with early RA.
abstract: OBJECTIVE
  To compare baseline characteristics, responses and drug survival in patients with early RA starting SSZ or MTX in a real-life setting.
  
  
  METHODS
  The analyses included DMARD-naïve patients with RA (disease duration ≤ 1 year) starting SSZ or MTX. Three- and 6-month effectiveness was compared by unadjusted analysis and with adjustment for propensity score quintile. In addition, effectiveness in SSZ- and MTX-treated patients matched for RF status and baseline DAS-28 was compared.
  
  
  RESULTS
  SSZ-treated patients (n = 175) had lower baseline disease activity than patients treated with MTX (n = 927) [mean 28-joint DAS (DAS-28) 4.4 vs 5.0, P < 0.001], and were less often RF positive (50 vs 61%, P = 0.006). Six-month mean ΔDAS-28 was smaller with SSZ than MTX (-1.0 vs -1.5, P = 0.003); the difference was not significant after adjustment for propensity score quintile (P = 0.36). For SSZ/MTX, 3-month ACR50 and European League Against Rheumatism (EULAR) good responses were 9/23% (P < 0.001) and 24/31% (P = 0.14), respectively. Three-year drug survival was superior for MTX (P < 0.001) and estimated 1-year survival rates were 42/75% for SSZ/MTX. In patients matched for baseline DAS-28 and RF, mean ΔDAS-28 (MTX -1.2, P = 0.55 vs SSZ) and EULAR good responses (39 vs 37%, P = 0.74) were similar at 6 months; drug survival was superior for MTX (P < 0.001).
  
  
  CONCLUSIONS
  Patients treated with SSZ as first DMARD were more often RF negative and had lower baseline disease activity. Drug survival was superior for MTX, and effectiveness was greater with MTX than with SSZ although the difference was reduced when adjusting for differences in baseline characteristics.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway. elisabeth_lie@yahoo.no
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.forename: Synøve
authors.initials: S
authors.lastname: Kalstad
authors.forename: Cecilie
authors.initials: C
authors.lastname: Kaufmann
authors.forename: Knut
authors.initials: K
authors.lastname: Mikkelsen
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use*; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents; D012460:Sulfasalazine; D012217:Rheumatoid Factor; D008727:Methotrexate