Table 1.

Combination DMARD strategies.

Treatment Strategy TypeDescriptionStudies from which Trial Arm Drawn (reference number)
MonotherapyDMARD monotherapy(5, 1725)
Parallel combinationTwo or more DMARD given in combination at the same time(5, 7, 1723, 26)
Step-up combinationPatients begin with DMARD monotherapy, and a second DMARD is added if an inadequate response is observed (within first 6 months)(5, 6)
Step-down combinationInitial parallel combination followed by downward dose titration and withdrawal(24, 27)
Intensive step-up combinationPatients begin with a DMARD parallel combination strategy, and rapid dose increases are made where an inadequate response is observed (within first 6 months)(6, 26)
Steroid plus monotherapyGlucocorticoids routinely used alongside a DMARD monotherapy regimen (the other combination strategies use steroids on an “as needed” basis(7, 25, 27)
  • DMARD: disease-modifying antirheumatic drug.