Future rheumatoid arthritis treatment could focus on DMARDs over methotrexate

The role of disease-modifying antirheumatic drugs (DMARDs) may evolve even further in rheumatoid arthritis treatment after a review of the evidence is published by the European League against Rheumatism.
Treatment of rheumatoid arthritis has improved substantially during the last decades thanks to the new, highly efficacious DMARDs, more optimal usage of them, earlier diagnosis and tighter control of disease activity.
Methotrexate is still the anchor drug and the first-line treatment after diagnosis and leads to remission in a maximum of half of patients.
But many studies comparing methotrexate and biologic DMARDs, as well as new targeted synthetic DMARDs, have shown better efficacy of DMARDs compared with methotrexate. This suggests that people could be given a biologic or a targeted synthetic DMARD earlier, which is then discontinued when stable remission is reached.
“Several trials have found there might be a clinical and structural benefit of initial, aggressive therapy, possibly even associated with higher chance of remaining in remission, after cessation of the biologic DMARD and continuing with methotrexate alone,” the experts say. “This might become a valuable option for the future treatment algorithm of rheumatoid arthritis but confirmation from more research is needed first.”
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