Intended for healthcare professionals


Drug treatments for rheumatoid arthritis: looking backwards to move forwards

BMJ 2015; 350 doi: (Published 13 March 2015) Cite this as: BMJ 2015;350:h1192
  1. Pierre Miossec, professor of clinical immunology
  1. 1Department of Clinical Immunology and Rheumatology and Immunogenomics and Inflammation research Unit, University of Lyon, Edouard Herriot Hospital, 69437 Lyon, France
  1. pierre.miossec{at}

New combinations of older drugs can be effective and affordable

Over the past 40 years the clinical picture has improved for patients with rheumatoid arthritis thanks to key steps in drug development and care strategy. These steps include the introduction of methotrexate in 1980 and the first inhibitors of tumour necrosis factor (TNF) in 2000. This was followed by the development of new biotechnology products to target other cytokines, cell subsets, and cell interaction pathways. All these products are expensive drugs with obvious consequences for health systems with limited resources.

In parallel, trials have also continued to test old drugs used in new more modern ways, starting with the combination of methotrexate, sulfasalazine, and hydroxychloroquine. The real surprise came from a recent demonstration that this combination was as effective as the combination of methotrexate and the TNF inhibitor etanercept.1 2 The linked paper by Scott and colleagues (doi:10.1136/bmj.h1046) is another example of a trial of TNF inhibitors compared with intensive treatment comprising a combination of conventional disease modifying anti-rheumatic drugs.3 The primary objective of this non-inferiority trial was to examine whether the drug combination could achieve similar clinical benefits to a TNF inhibitor …

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