The efficacy and XXXX of combination therapy in @entity309 . A meta-analysis.

@entity1 @entity137 @entity309
OBJECTIVE: To evaluate the efficacy and @entity137 of combination therapy, compared with single second-line drug therapy, in @entity309 . METHODS: This study was a meta-analysis of published trials that evaluated combinations of full-dose second-line drugs and compared them with single second-line drugs at full dose. Using a random effects model, we summarized the difference between improvement with combination therapy and improvement with single-drug therapy. RESULTS: Five trials that met inclusion criteria, which contained 749 entering @entity1 and 516 completing @entity1 , were identified. The mean +/- SEM difference in improvement in tender joint count between combination and single-drug therapy at end of trial (24-52 weeks) was 2.4 +/- 0.7 joints (out of 60) (P < 0.001). At end of trial the difference between therapies in swollen joint counts was 1.0 +/- 1.2 joints (P = 0.42). The difference in grip strength improvement was 3.7 +/- 4.3 mm Hg (P = 0.40), and for erythrocyte sedimentation rate it was 3.4 +/- 3.1 mm/hour (P = 0.27). In general, the differences in efficacy between combination and single-drug therapy were clinically marginal. Nine percent more combination therapy-treated @entity1 experienced side effect-related discontinuation of therapy than @entity1 receiving single-drug therapy (P = 0.008). CONCLUSION: Combination therapy, as it has been used in recent clinical trials, does not offer a substantial improvement in efficacy, but does have higher @entity137 than single drug therapy. These combination therapy regimens are not recommended for widespread use. Other more aggressive regimens with additional drugs or higher drug doses than have been studied might be more efficacious, but with an even higher rate of @entity137 .
