An analysis of nationwide insurance claims showed that despite evidence that methotrexate, sulfasalazine, and hydroxychloroquine in combination is similar in efficacy to biologic therapy and  less costly, this triple therapy is not often used to treat rheumatoid arthritis  in clinical practice. One possible explanation is that people still believe in the biologics more than the conventional DMARDs. There also is currently no mandate to use triple therapy per guidelines and prescribing rules by payers.

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