Anti-TNF drugs in combination with methotrexate are recommended as a second-line treatment for rheumatoid arthritis (RA) if patients fail to respond to DMARDs, according to NICE.
But a systematic review of 23 head-to-head trials into RA drugs showed no major or clinically important differences between the two types of drugs when used as monotherapy.
All of the trials studied included at least 100 participants and 12 weeks' follow-up. Anti-TNF drugs studied included adalimumab, etanercept and infliximab, and DMARDs were limited to methotrexate, leflunomide and sulfasalazine.
In trials comparing monotherapy with each type of drug, anti-TNF drugs resulted in better radiographic outcomes than other DMARDs.
However, when the American College of Rheumatology (ACR) response criteria was considered there was little difference in outcomes for ACR 20, 50 or 70 response rates.
Overall, combinations of treatment were found to be more effective than monotherapy.
But there is insufficient evidence to decide which combination is best, said the researchers.
They warn that, because most of the studies considered were short term, long-term safety issues may change the benefit and harm ratios of the different types of drugs.
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