Swefot Trial Suggests Adding TNF Inhibitor Better than Triple Therapy in RA Patients who do not Rapidly Respond to Methotrexate

Initial combination therapy has been shown to be superior to step-up combination therapy in groups of RA patients; however, these findings are difficult to reconcile with the observation that many RA patients will have complete remission of disease on methotrexate alone. Practice patterns tend to emphasize initial treatment with methotrexate monotherapy, followed by the addition of other agents in combination for those with inadequate responses.