According to the researchers of University of Ferrara and Italian Society for Rheumatology (SIR) Italy, the combination of bDMARDs and csDMARDs is efficacious in RA treatment. Concomitant use of methotrexate, leflunomide and csDMARDs in combination is also associated with longer survival on bDMARD.

The Ettore Silvagni and colleagues conducted a retrospective observational study by considering Administrative Healthcare Databases. The RA patients who began first-line recommended the course of bDMARDs were included. Cox proportional hazard models were employed to measure drug survival among these patients. HRs and 95% CI along with crude and adjusted for prespecified confounders used to present the result of the analysis. Prespecified confounders used in this study were sex, disease duration, age, previous infections, use of concomitant glucocorticoids or non-steroidal anti-inflammatory drugs (NSAIDs), and Charlson Comorbidity Index (CCI).

A total of 4478 RA patients were involved with 17.84% monotherapy rate. The first line biologics for the management were Etanercept, Infliximab, and Adalimumab. Higher CCI, lower NSAIDs & glucocorticoids use, and longer disease duration was noticed during the bDMARD monotherapy while combined treatment reflected reduced failure risk. Acknowledging Etanercept as a reference, Infliximab and Adalimumab exhibited higher failure risk and lower retention rate among the monotherapies. However, in the combination therapy, csDMARD, leflunomide, or methotrexate combinations lowers the risk of bDMARD withdrawal. As per the findings, csDMARD and bDMARD combination proven to be significant combination therapy for rheumatoid arthritis treatment.