The open label TACIT trial included patients with rheumatoid arthritis who were eligible for TNF inhibitors under current NICE guidance. A total of 101 patients started treatment with a TNF inhibitor (most common, adalimumab – 58/101) and 104 patients started treatment with the various DMARD combinations used in routine practice (most common, methotrexate and leflunomide - 62/104).
The primary outcome, score on the health assessment questionnaire at 12 months, decreased in both groups, but slightly more in the group treated initially with DMARDs (−0.45 v −0.30). Changes in quality of life, progression of erosions, rate of induction of remission (44/101 with TNF v 36/104 with combination drugs), and serious adverse events (18/101 v 10/104) were comparable in both treatment arms.
Conversely, DMARD drug combinations were associated with lower health and social care costs, saving £3615 per patient during in the first six months and £1930 per patient during months 6-12.
Overall these data suggest that a combination of traditional drugs is not inferior to a biological option. However, a related editorial notes it is still unclear which combination of DMARDs is most effective. Long term studies in a larger population are required to confirm these findings with focus on joint destruction and disability.