Combination Therapy More Effective for People with Early RA

Newswise — Patients receiving doxycycline plus methotrexate as first line of treatment showed greater improvement than patients on methotrexate alone, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Orlando, Florida.

A two-year trial of 66 patients with rheumatoid arthritis of less than one year duration who had not previously been treated with disease-modifying antirheumatic drugs (DMARDs) was conducted to compare the efficacy of doxycycline at two different strengths plus methotrexate, versus methotrexate alone. Eighteen patients received a low dose of doxycycline (20mg twice a day) plus methotrexate, 24 patients received a higher dose of doxycycline (100mg twice a day) plus methotrexate, and 24 patients received placebo plus methotrexate. All patients were started on the same dose of methotrexate, which was adjusted every three months as necessary. Results showed that 62.5% of patients receiving 100mg doxycycline twice a day plus methotrexate achieved significant improvement in their arthritis as measured by standard criteria of disease activity developed by the American College of Rheumatology (known as the ACR 20, 50, 70), compared to 38.8% of patients receiving low dose doxycycline (20 mg twice a day) and methotrexate, and 33% of patients receiving methotrexate alone. Eight patients, including 6 patients taking doxycycline and 2 taking placebo, were withdrawn from the study due to adverse reactions.

"Over the last decade methotrexate has unquestionably become the gold standard of treatment for rheumatoid arthritis, particularly in early disease," said James O'Dell, MD, Professor of Internal Medicine and Chief of Rheumatology, University of Nebraska Medical Center and an investigator in the study. "This trial has shown that patients who had a relatively inexpensive medication, doxycycline, added to methotrexate had significantly better outcomes than patients treated with methotrexate alone."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.