HealthDay News – Despite research suggesting that triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine is equal in efficacy to biological disease-modifying antirheumatic drugs (bDMARDs) for the treatment of rheumatoid arthritis (RA), the use of triple therapy was infrequent in a nationwide study in the U.S. These results were published in the July issue of Arthritis & Rheumatology.

Jeffrey A. Sparks, MD, from Brigham and Women’s Hospital in Boston, and colleagues used U.S. insurance claims data to examine use of triple therapy among patients with RA in 2009 to 2014. 

The frequency of intensification to triple therapy or a bDMARD and rates of intensification per six-month time period were evaluated. Factors associated with use of triple therapy were identified.

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High Yield Data Summary

  • Factors tied to triple therapy treatment intensification included age, geographic region, number of outpatient visits, and glucocorticoid use

Data were included for 24 576 patients (78% female). The researchers found that treatment was intensified to bDMARDs in 11.1% of patients and to triple therapy in 0.7%of patients during the study period. Across calendar years there was no significant change in triple therapy use. 

Patients whose treatment was intensified to triple therapy were more likely to receive glucocorticoids and nonsteroidal anti-inflammatory drugs (hazard ratios, 1.91 and 1.48, respectively). 

Factors significantly associated with triple therapy use included older age, U.S. region (highest odds for use in West and lowest in Northeast), glucocorticoid use, and lower number of outpatient visits.

“Despite reports published during the study period suggesting equivalent efficacy of triple therapy and [bDMARDs] for RA, the use of triple therapy was infrequent and did not increase over time in this large nationwide study,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry, including CVS Health, which provided funding for the study.


Sparks JA, Krumme AA, Shrank WH, et al. Brief Report: Intensification to Triple Therapy After Treatment With Nonbiologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis in the United States From 2009 to 2014. Arthritis Rheumatol. 2016;68(7):1588-95. DOI: 10.1002/art.39617

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