Methotrexate in combination with sulfasalazine is more effective in rheumatoid arthritis patients who failed sulfasalazine than in patients nave to both drugs

Methods. A systematic literature search was performed to identify RCTs that compared the MTXSSZ combination to either drug alone. The databases MEDLINE and the Cochrane Clinical Trials registry were searched from 1966 up to April 2007. The efficacy of the single therapeutic agents or their combination was assessed using the mean change in the disease activity score (DAS) and the ACR improvement criteria. Results. Four RCTs were identified to compare the efficacy of the combination MTXSSZ to the efficacy of either drug alone. Two parallel trials were performed with patients nave to both drugs and two add-on trials were performed in SSZ failures. In the trials with nave patients, the mean DAS changes for the combination MTX and SSZ pointed to a sub-additive efficacy. In the trials with patients who previously failed to SSZ, the mean DAS changes for the combination MTX and SSZ indicated additive efficacy. Conclusions. In RA, addition of MTX to SSZ is a therapeutic option in SSZ failures, whereas combination of MTX and SSZ in DMARD-nave patients has no added value.