If you have rheumatoid arthritis (RA), most doctors will treat you as aggressively as needed to get you to remission or at least a low level of disease activity. (This is known as “treat-to-target.”) You might reach your goal with methotrexate alone, or you might need to add a biologic drug (which targets a more specific part of the immune system) to the mix. But what happens if you’re still not in remission? Should you add a second biologic to your drug regimen?
Although some animal research has suggested that using two different types of biologics might be worthwhile, a recent study that examined adverse effects in humans found that it’s a risky move.
The study, published in Seminars in Arthritis and Rheumatism, was a meta-analysis of six earlier trials. It included data on more than 600 people with RA who had recently started taking one or two biologics, and the difference was clear. Nearly 15 percent of those who were taking two biologics experienced a serious adverse event within a year, such as an infection that warranted hospitalization. In contrast, just 6 percent of RA patients who were using a single biologic experienced a serious adverse event in that time.
What’s more, taking two biologic drugs simultaneously didn’t do a better job of controlling disease activity, either, according to five of the six study findings that were analyzed. The sixth study, an observational study (the others were clinical trials), found some benefit to combining rituximab (Rituxan) and etanercept (Enbrel). “The question of efficacy of a combination strategy should deserve further investigation in real-world settings,” the authors wrote.
In the meantime, patients and physicians should focus on the main takeaway of this analysis, which is that using two biologic drugs for RA seems to increase the chances that a serious adverse event will occur.
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- Understanding Seronegative Rheumatoid Arthritis: What It Is, and Isn’t