Effectiveness of sulfasalazine and methotrexate in 1102 DMARD-naïve patients with early RA

Objective. To compare baseline characteristics, responses and drug survival in patients with early RA starting SSZ or MTX in a real-life setting. Methods. The analyses included DMARD-naive patients with RA (disease duration4 1 year) starting SSZ or MTX. Three- and 6-month effectiveness was compared by unadjusted analysis and with adjustment for propensity score quintile. In addition, effectiveness in SSZ- and MTX-treated patients matched for RF status and baseline DAS-28 was compared. Results. SSZ-treated patients (n = 175) had lower baseline disease activity than patients treated with MTX (n = 927) (mean 28-joint DAS (DAS-28) 4.4 vs 5.0, P < 0.001), and were less often RF positive (50 vs 61%, P = 0.006). Six-month mean DAS-28 was smaller with SSZ than MTX (1.0 vs 1.5, P = 0.003); the difference was not significant after adjustment for propensity score quintile (P = 0.36). For SSZ/MTX, 3-month ACR50 and European League Against Rheumatism (EULAR) good responses were 9/23% (P < 0.001) and 24/31% (P = 0.14), respectively. Three-year drug survival was superior for MTX (P < 0.001) and estimated 1-year survival rates were 42/75% for SSZ/MTX. In patients matched for base- line DAS-28 and RF, mean DAS-28 (MTX 1.2, P = 0.55 vs SSZ) and EULAR good responses (39 vs 37%, P = 0.74) were similar at 6 months; drug survival was superior for MTX (P < 0.001).