Rheumatoid Arthritis

Start with DMARD monotherapy with low disease activity

2 recommendations stand out for me as not consistent with the available evidence:

1) for early disease not adequately controlled with a conventional synthetic DMARD like MTX, anti-TNF is to be preferred over (Xeljanz) Tofacitinib, when the latter’s trials (ORAL Solo and ORAL Start) showed Xeljanz”s efficacy even as standalone and as first line therapy in MTX-naïve patients;

2) a csDMARD like MTX can be “optional” when anti-TNFs are used, when all anti-TNF trials in RA showed superior efficacy in combination, compared to MTX alone or anti-TNF alone.

Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in
patients with rheumatoid arthritis (RA)…