Patients with rheumatoid arthritis (RA) who start treatment with intensive combinations of synthetic disease-modifying antirheumatic drugs (cDMARDs) achieve similar results at significantly lower cost compared with those taking tumor necrosis factor inhibitors (TNFis), according to results published in Arthritis Care & Research.

The study included participants with RA from 24 rheumatology clinics in England who were randomly assigned to cDMARDs or TNFis for 12 months. The researchers linked cost to the Health Assessment Questionnaire (HAQ) and quality-adjusted life-years derived from 36-item Short Form Health Survey and EQ-5D-3L.

Of 205 participants, 104 were randomly assigned to the cDMARDs group and 101 were randomly assigned to the TNFi group. After 6 months, participants in the cDMARD group who had poor responses were offered TNFis, and 44% (n=46) switched treatments.

The researchers found significantly lower total costs in all measures for the cDMARD group. At 6 months, the health and social care adjusted mean difference was -£3615 for the cDMARD group compared with the TNFi group. At 12 months, the health and social care adjusted mean difference was -£1930.

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At 12 months, HAQ scores showed a benefit in the cDMARDs arm compared with the TNFi arm (-0.16), but other outcomes and follow-ups showed no differences.

“This economic evaluation suggests that for patients with established RA who have failed to respond to methotrexate and another DMARD, beginning treatment with cDMARDs is a more cost-effective treatment approach, since it provides equivalent outcomes to starting treatment with TNFis and either avoids or delays additional costs associated with the more expensive TNFis,” the researchers wrote.

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Reference

Patel A, Heslin M, Scott DL, Stringer D, Birrell F, Ibrahim F. Cost-effectiveness of combination disease-modifying antirheumatics vs. tumour necrosis factor inhibitors in active rheumatoid arthritis: TACIT trial. [published online January 10, 2019]. Arthritis Care Res. doi:10.1002/acr.23830