Combination DMARD strategies.
| Treatment Strategy Type | Description | Studies from which Trial Arm Drawn (reference number) |
|---|---|---|
| Monotherapy | DMARD monotherapy | (5, 17–25) |
| Parallel combination | Two or more DMARD given in combination at the same time | (5, 7, 17–23, 26) |
| Step-up combination | Patients begin with DMARD monotherapy, and a second DMARD is added if an inadequate response is observed (within first 6 months) | (5, 6) |
| Step-down combination | Initial parallel combination followed by downward dose titration and withdrawal | (24, 27) |
| Intensive step-up combination | Patients 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 monotherapy | Glucocorticoids 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.