The aim of the analysis was to determine the incremental cost-effectiveness ratios (ICERs) of etanercept–methotrexate versus triple therapy (using three DMARDs; methotrexate, sulfasalazine and hydroxychloroquine) as first step-up treatment for patients with active rheumatoid arthritis unresponsive to methotrexate monotherapy.
The researchers conclude that initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit, and does not provide good value.
In a related editorial, authors discuss the findings of this study in the context of accepted willingness-to-pay thresholds in the United States.
The RACAT study, as well as 3 other RCTs have been investigated in a recent systematic review of triple therapy vs methotrexate plus anti-TNF in patients who do not respond to methotrexate alone. Though there were improved responses with biologic plus methotrexate therapy. The authors report that triple therapy retains its place in the therapeutic strategy for rheumatoid arthritis in a currently restricted economic context.