Utility of disease modifying antirheumatic drugs in 'sawtooth' strategy. A prospective study of early rheumatoid arthritis patients up to 15 years

Abstract

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. Methods - A 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. Results - During 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 inefficacy, toxicity or drug survival. Conclusion - The 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.