Extended report
Utility of disease modifying antirheumatic drugs in
"sawtooth" strategy. A prospective study of early rheumatoid
arthritis patients up to 15 years
T Sokka, P Hannonen
Department of
Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FIN
40620 Jyväskylä, Finland
Correspondence to: Dr T Sokka.
Accepted for publication 21 May 1999
OBJECTIVES
To
study long term utility of early, continual, and serial use of
disease modifying antirheumatic drugs (DMARDs) in early rheumatoid
arthritis (RA) in clinical setting.
METHODSA total of 135 patients with early RA were treated according to the "sawtooth"
strategy and prospectively followed up to 15 years. DMARD survivals as
well as reasons for drug terminations were documented and are reported here.
RESULTSDuring 1401 person years of follow up, a DMARD or a combination of two or several
DMARDs (COMBOs) was started 606 times. A total of 528 drug periods were
terminated because of inefficacy, adverse effects, remission, and other
reasons in respective 270 (51.1%), 149 (28.2%), 32 (6.1%), and 77 (14.6%) cases. Severe drug related adverse events were rare. The
median duration of DMARD periods of individual DMARDs or COMBOs was 10 months ranging from six to 18 months. Not a single DMARD/COMBO stood
out favourably from the others with respect to ineffecacy, toxicity or
drug survival.
CONCLUSIONThe use of
serial DMARDs/COMBOs was safe even in the long run. Inefficacy rather
than toxicity was the leading reason for drug terminations. More
powerful drug therapies are needed.
© 1999 by Annals of the Rheumatic Diseases
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