Comparison of the Effect of Disease: Modifying Antirheumatic Drugs Alone or in Combination with Biologic Drugs in the Outcome of Patients with Rheumatoid Arthritis

Document Type : Original Article


Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Rheumatoid arthritis (RA) is a rheumatic disease that could be disabling if not treated. The aim of RA therapy is to resolve tenderness and swelling in the joints. The present study was conducted to compare two methods of RA treatment with disease-modifying anti-rheumatic drugs (DMARDs) and DMARDs with biologic drugs in two groups of patients.
Materials and Methods: The present study was a nonrandomized clinical trial which was conducted from July to September 2017 on 110 patients who were selected based on the American College of Rheumatology (2010) criteria for RA. Patients were divided into two groups of 55: Groups A and B. For the treatment of Group A, prednisolone along with one or two drugs from the DMARDs combinations was used. Group B received one biologic drug besides with the drugs of the group A. T-test and covariance analysis was used to compare the outcomes of both groups.
Results: Disease activity score (DAS-28) at the beginning of the study was 4.23 (0.81) in Group A and 4.51 (0.7) in Group B (P = 0.05). At the end of the study, DAS-28 was 3.52 (0.79) in Group A and 3.75 (0.85) in Group B (P = 0.1). DAS-28 activity index had a significant difference between both two groups at the beginning of the study (P = 0.05), but at the end of the study, the difference was not statistically significant (P = 0.1).
Conclusions: Simultaneous use of DMARDs and biologic drugs in RA patients could lead to improvement the disease symptoms and decrease the severity and activity of the disease.


Garys F, Ralph C. Kelly Text Book of Rheumatology. 10th ed. Philadelphia: Elsevier Saunders Publication: 2017. p. 1188-213.  Back to cited text no. 1
Hochbergg MC, Silman A. Rheumatology. 5th ed. Philadelphia: Elsevier Mosby Publication: 2014.  Back to cited text no. 2
Singh JA, Saag KG, Bridges SL Jr., Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016;68:1-26.  Back to cited text no. 3
Ramiro S, Sepriano A, Chatzidionysiou K, Nam JL, Smolen JS, van der Heijde D, et al. Safety of synthetic and biological DMARDs: A systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2017;76:1101-36.  Back to cited text no. 4
Schett G, Emery P, Tanaka Y, Burmester G, Pisetsky DS, Naredo E, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: Current evidence and future directions. Ann Rheum Dis 2016;75:1428-37.  Back to cited text no. 5
Pavlovic V, Dimic A, Milenkovic S, Krtinic D. Serum levels of IL-17, IL-4, and INFγ in Serbian patients with early rheumatoid arthritis. J Res Med Sci 2014;19:18-22.  Back to cited text no. 6
Aryaeian N, Djalali M, Shahram F, Djazayery A, Eshragian MR. Effect of conjugated linoleic acid, vitamin e, alone or combined on immunity and inflammatory parameters in adults with active rheumatoid arthritis: A randomized controlled trial. Int J Prev Med 2014;5:1567-77.  Back to cited text no. 7
Inui K, Koike T. Combination therapy with biologic agents in rheumatic diseases: Current and future prospects. Ther Adv Musculoskelet Dis 2016;8:192-202.  Back to cited text no. 8
Dewitt EM, Li Y, Curtis JR, Glick HA, Greenberg JD, Anstrom KJ, et al. Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis. J Rheumatol 2013;40:127-36.  Back to cited text no. 9
Nurmohamed MT, Dijkmans BA. Are biologics more effective than classical disease-modifying antirheumatic drugs? Arthritis Res Ther 2008;10:118.  Back to cited text no. 10
Soliman MM, Ashcroft DM, Watson KD, Lunt M, Symmons DP, Hyrich KL, et al. Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: Results from the British Society for Rheumatology biologics register. Ann Rheum Dis 2011;70:583-9.  Back to cited text no. 11
Gallo G, Brock F, Kerkmann U, Kola B, Huizinga TW. Efficacy of etanercept in combination with methotrexate in moderate-to-severe rheumatoid arthritis is not dependent on methotrexate dosage. RMD Open 2016;2:e000186.  Back to cited text no. 12