Triple therapy with non-biologic DMARDs for rheumatoid arthritis or biologic therapy. Is it the same?

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Is it the same?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "345" "paginaFinal" => "346" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Abud-Mendoza, Marco U. Martínez-Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carlos" "apellidos" => "Abud-Mendoza" "email" => array:1 [ 0 => "c_abud@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Marco U." "apellidos" => "Martínez-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad Regional de Reumatología y Osteoporosis, Hospital Central “Dr. Ignacio Morones Prieto” y Facultad de Medicina de la Universidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P., México" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Triple terapia con FARME no biológico o tratamiento biológico para artritis reumatoide. ¿Son lo mismo?" ] ] "textoCompleto" => "The goals for rheumatoid arthritis (RA)—remission or low disease activity— are achieved through combination therapy with disease-modifying antirheumatic drugs (DMARDs) or biologic therapy. DMARDs combination therapy achieve the goals in higher percentage than DMARD monotherapy<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>. Recently O’Dell et al. compared triple therapy with three non-biologic DMARDs, and biologic therapy with etanercept-methotrexate in RA<a class="elsevierStyleCrossRef" href="#bib0015">3</a>. This comparison is important for developing countries because the poor availability through social security<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.O’Dell and colleagues did not find significant differences in DAS28 (using erythrocyte sedimentation ratio, ESR or C reactive protein, CRP). Even DAS28 is considered the “gold standard” for evaluating disease activity, other clinical measures such as ultrasound or MRI might improve sensitivity for the targets in RA patients<a class="elsevierStyleCrossRefs" href="#bib0025">5–8</a>. The study reported that patients receiving biologic therapy achieved American College of Rheumatology ACR50 and ACR70 almost 10% higher than triple therapy. Previous studies informed improved productivity of daily work8 and slow or not radiographic progression in patients under biologics therapy, although the significance related with the structural differences is not clinically defined<a class="elsevierStyleCrossRefs" href="#bib0005">1,9,10</a>. It is clear that there are benefits for patients receiving biologic therapy.The clinical benefits of triple therapy previously mentioned are relevant in most RA patients when compared to efficacy of DMARD combination. This is especially an attractive treatment because of the lower cost of triple therapy compared to biologics, particularly in developing countries. Although we do not have official data related with social security in México, approximately 20% of RA patients covered by ISSSTE (11% of total Mexican population), and less than 5% of IMSS (59% of total Mexican population) are receiving a biological therapy; Mexican population with no social security is a rare event to prescribe biologic therapy. However, although triple therapy can be more accessible than biologics, the latter treatment becomes necessary for at least in 20-30% of RA patients particularly when individual treatment is refractory to methotrexate. Nonetheless, treatments with higher doses of methotrexate<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>, in combination with prednisone<a class="elsevierStyleCrossRef" href="#bib0065">13</a> or with another combination of DMARD, reduces the percentage of patients requiring biologics therapy<a class="elsevierStyleCrossRefs" href="#bib0005">1,14,15</a>. We suggest that initial triple DMARDs therapy for RA as the first therapy for monotherapy non-responsive patients and biologics must be reserved for refractory triple DMARDs therapy." "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the NEO-RACo Study Group" "etal" => true "autores" => array:6 [ 0 => "V. Rantalaiho" 1 => "H. Kautiainen" 2 => "M. 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