The usefulness of a new triple combination treatment utilizing methotrexate, salazosulfapyridine, and bucillamine in rheumatoid arthritis

Abstract

Objectives. Combination treatment with methotrexate, salazosulfapyridine and bucillamine as an alternative to treatment with TNF-inhibiting biologics in rheumatoid arthritis was investigated.

Methods. Twenty-six facilities allied with the Japan Association of Rheumatologists in Private Practice participated in this study. One hundred and twelve patients enrolled in this study, all of whom were within 3 years of diagnosis with rheumatoid arthritis for whom treatment with one DMARD or a combination of two DMARDs had failed (DAS28 > 3.2). Patients chose their own treatment. The triple DMARDs combination group was comprised of 72 patients; the TNF-inhibiting biologics treatment group was comprised of 40 patients.

Results. DAS28 scores for the triple DMARDs combination group and the TNF-inhibiting biologics treatment groups were 4.84 ± 0.96 and 5.23 ± 1.26, and there was no significant difference between the two groups. From the 6th month, average disease activities of both groups were reduced, and there was no difference between the two groups at 12 months (DAS28, 3.39 ± 1.43 and 3.05 ± 1.43, p = 0.39). Furthermore, there was no significant difference in the degree of bone destruction between the two groups at 12 months.

Conclusions. The triple DMARD combination therapy provided a new treatment option for those patients for whom treatment with biologics is difficult.

Keywords:

• Antirheumatic agents
• Bucillamine
• Methotrexate
• Rheumatoid arthritis
• Sulfasalazine

Acknowledgement

We thank all patients and the following rheumatologists (additional to the author) who participated in the JaSTAR study group (all locations are in Japan): Minami M., Suzuki K. (Hokkaido Orthoprediec Memorial Hospital); Yoshida M. (Yoshida Orthopaedic Clinic); Izumiyama T. (East Sendai rheumatism and internal medicine clinic); Sakurai T. (Inoue Hospital); Nakamura H. (Department of Rheumatology, Saitama neurosurgical institute); Tokano Y. (Tokano Hospital); Tsuchida T. (Tsuchida Clinic); Kim K. (Kioicho Medical Clinic); Yoshida T., Katsuyama N., Kato T., Nakano H. (Setagaya Rheumatology Center Yoshida Naika Clinic); Kiyokawa S. (Fujimori Clinic); Miyamoto S. (Miyamoto Clinic); Mannami K., Mitsuhashi T. (Mannami Orthopedic Clinic); Hashimoto K. (Hashimoto Clinic); Fujimori J. (Hohfu Orthopedic and Rheumatoid Arthritis Clinic); Shono E. (Shono Rheumatism Clinic); Tsuru T. (PS Clinic); and Oribe M. (Oribe Rheumatism and Medicine Clinic). Support for data management and statistical analysis was provided by Biostatistical Research. This support was funded by Santen pharmaceutical Co. Ltd. with no involvement in the management and analysis of any data. We wish to thank Santen pharmaceutical Co. Ltd. who provided logistic support for our study group.

Conflict of interest

The Japan Association of Rheumatologists in Private Practice was founded by Santen pharmaceutical Co. Ltd.

None.