True about combination therapy with anakinra and infliximab in rheumatoid arthritis patients is:
Ans. A. Combination should be avoidedRef: Harrison's Principles of Internal Medicine 19th/ed, p2147Explanation# Option a: Anakinra (IL 1 antagonist) and infliximab (anti-TNF) should not be combined.# Both agents restrict inflammatory process markedly and lead to high rate of serious infections.# This finding is observed in trials that used this regimen.# New strategy in treatment of RA focuses on several goals:1. Early, aggressive therapy to prevent joint damage and disability.2. Frequent modification of therapy and use of combination therapy where appropriate.3. Individualization of therapy, to maximize response and minimize side effects;4. Achieving, remission of clinical disease activity.# Preferred first line drug as monotherapy in moderate to severe RA: Methotrexate# Effective combinations include:# Methotrexate, sulfasalazine, and hydroxychloroquine (oral triple therapy);# Methotrexate and leflunomide;# Methotrexate plus a biological (e.g. methotrexate and infliximab an anti-TNF agent; methotrexate + Etanercept is equivalent to oral triple therapy options b and d)# Early RA (<6 months of disease duration)# Started with methotrexate - switch or add DMARD therapy after 3 months of worsening or persistent moderate/high disease activity - If disease still persists after 3 months of intense DMARD therapy, add a biologic agent.# Oral triple therapy (hydroxychloroquine, methotrexate, and sulfasalazine) is a reasonable first step for the treatment of early RA, including its use as a step-up strategy where treatment is initiated with methotrexate alone and then combined at 6 months with hydroxychloroquine and sulfasalazine if the disease is not adequately controlled.# Patients with established RA.# Treatment with a biologic agent or aggressive combination DMARD therapy was also recommended as initial therapy in certain patients with high disease activity and poor prognosis.
Combination should be avoided
Combination is superior to methotrexate plus etanercept
Combination is superior to methotrexate alone
Combination is equally effective as oral triple therapy
Immunomodulator