A Swedish nationwide prospective study suggests that adding conventional DMARDs (such as sulfasalazine or methotrexate) to anti-TNF therapy may help spondyloarthritis patients remain longer on the anti-TNF medication they are taking.
The investigators conducted an analysis of the Swedish national biologics registry, looking at the records of 1,365 ankylosing spondylitis patients and 1,155 undifferentiated spondyloarthritis patients. They concluded that, “comedication with conventional DMARD and anti-TNF therapy was significantly associated with a longer duration of use of the first anti-TNF agent among patients with both ankylosing spondylitis and undifferentiated spondyloarthritis… This effect was significant even after adjusting for inflammation, as measured by C-reactive protein and erythrocyte sedimentation rate, as well as the presence of other clinical manifestations, including swollen peripheral joints, uveitis, psoriasis, and inflammatory bowel disease.”
As the study was a registry based analysis, it is difficult to identify the exact cause of the correlation. However, as we know that lack of efficacy and adverse reactions are leading causes of discontinuation of anti-TNF therapy, these findings could suggest that DMARDs do indeed improve anti-TNF efficacy. “In particular, it is possible that concomitant use of a conventional DMARD may lead to less immunogenicity against anti-TNF agents, thereby promoting the efficacy of the anti-TNF agent, as well as perhaps fostering fewer adverse reactions that may develop from immune reactions to the drug.”
For further reading see Medscape.
Ann Rheum Dis annrheumdis-2014-206616, Published Online First: 20 February 2015
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