Patients who have been successfully treating their RA with a combination of Actemra and methotrexate can safely drop the methotrexate and continue on Actemra alone, researchers say.
In a randomized trial, patients had similar symptoms and side effects whether they continued on a combination of the two drugs or switched to Actemra alone.
Current guidelines recommend that patients who don’t get enough relief from methotrexate (the active ingredients in Rheumatrex, Trexall, Otrexup, Rasuvo) and similar drugs combine them with a biologic such as Actemra.
But many patients would prefer to drop methotrexate altogether because of side effects. “Patients are sometimes afraid – sometimes more afraid than their physicians – of continuing methotrexate for a long time,” said the lead research José Luis Pablos of the Hospital University 12 de Octubre in Madrid, Spain.
He and his colleagues wanted to see what would happen if patients who had been taking the two drugs together dropped the methotrexate.
So they divided some patients who were doing well on the two drugs for 16 weeks into two groups of 82 patients each. All the patients had a Disease Activity Score 28 (DAS28) of less than 3.2. One group continued on Actemra with methotrexate and the other continued on Actemra in combination with a placebo.
Twelve weeks later, the two groups had similar results. In the group continuing on the two-drug combination, 82.3% achieved remission according to the DAS28. In the group taking Actemra with a placebo, 75.9% achieved remission by this measure. The difference between the two was not statistically significant.
Using a different measure of remission, the Clinical Disease Activity Index, 40.7% of the two-drug group achieved remission, compared to 35.8% of the group taking Actemra with a placebo. Once again, the difference between the two was not statistically significant.
The side effects were similar as well. The two-drug group had 83 adverse events of which 1 was severe, while the Actemra-and-placebo group had 82 of which 3 were severe.
There were 19 infections and infestations in the two-drug group and 24 in the Actemra-plus-placebo group.
“This reinforces the idea that methotrexate is dispensable” with Actemra, said Pablos.
The same may not be true of other biologic treatments for RA, he cautioned.
The study was funded by Roche Pharmaceuticals, which makes Actemra.