RN Readers Poll: Even Split on Anti-TNF vs Triple Therapy

May 23, 2014

When methotrexate monotherapy does not provide adequate relief for rheumatoid arthritis, poll respondents equally favor adding triple therapy or a TNF inhibitor as the next step in treatment.

Initial results for the first Rheumatology Network Practice Poll show triple therapy with a slight edge over anti-tumor necrosis (anti-TNF) therapy for patients with rheumatoid arthritis (RA) in whom methotrexate monotherapy has not achieved remission.

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Among the first 44 rheumatologists responding to the poll posted online on April 30, nearly equal numbers favored "triple therapy," adding sulfasalazine and hydrochloride (18) or a TNF inhibitor (17) to methotrexate. Fewer respondents favored leflunomide (4), abatacept (3), or rituximab (3). None so far would add tocilizumab or tofacitinib. 

A recent study has found triple therapy plus MTX cost-effective for treatment of early RA. TNF inhibitors appear to reduce cardiovascular risks.

The weekly Practice Poll series, created by the Rheumatology Network Editorial Board, is intended to offer insights into favored practice in areas of rheumatology where best practices have not yet been formulated in clear guidance from expert bodies.

Rheumatologists who have not yet responded are urged to cast their vote (and add comments) at:

RN Practice Poll #1: Your Strategy After MTX Fails in RA

and a second poll, which inquires what to do when the first strategy fails:

RN Practice Poll #2: MTX Plus Anti-TNF Fails in RA. What Next?

Polls will remain online indefinitely, and a new poll is added every week.