TY - JOUR T1 - Effectiveness of Tumor Necrosis Factor Inhibitors in Combination with Various csDMARD in the Treatment of Rheumatoid Arthritis: Data from the DREAM Registry JF - The Journal of Rheumatology JO - J Rheumatol SP - 1787 LP - 1794 DO - 10.3899/jrheum.151014 VL - 43 IS - 10 AU - Sofie H.M. Manders AU - Wietske Kievit AU - Tim L.T.A. Jansen AU - Jan N. Stolk AU - Henk Visser AU - Annemarie M. Schilder AU - Harald E. Vonkeman AU - Eddy Adang AU - Mart A.F.J. van de Laar AU - Piet L.C.M. van Riel Y1 - 2016/10/01 UR - http://www.jrheum.org/content/43/10/1787.abstract N2 - Objective. To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire–Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice.Methods. Data were collected from the DREAM registry. Patients beginning their first TNFi treatment were included in the study: TNFi monotherapy (n = 320), TNFi + SSZ (n = 103), TNFi + LEF (n = 80), TNFi + other csDMARD (n = 99), TNFi + MTX alone (n = 919), TNFi + MTX + other csDMARD (n = 412). Treatment effectiveness was analyzed using DAS28 and HAQ-DI with linear mixed models and the TNFi drug survival was analyzed using Kaplan-Meier curves and Cox regression. All analyses have been corrected for confounders.Results. The patients who received TNFi + MTX had significantly better DAS28 and HAQ-DI values over time (both p < 0.001) and longer TNFi drug survival than TNFi monotherapy (p < 0.001). TNFi + SSZ and TNFi + other csDMARD had significantly better DAS28 values over time (p = 0.001) and longer drug survival (p = 0.001) versus TNFi monotherapy. TNFi + LEF was not significantly better compared to monotherapy. Adding other csDMARD to the TNFi + MTX combination provided no added value.Conclusion. Preferably, TNFi should be prescribed together with MTX. If this is not possible, we advise the use of other csDMARD. ER -