Purpose of Review

Compare benefits and harms of drug therapies for adults with early rheumatoid arthritis (RA) within 1 year of diagnosis.

Key Messages

• Conclusions are based on studies that enrolled patients with moderate to high disease activity at baseline as measured with Disease Activity 28 Scores and may not apply to the general RA population.
• Corticosteroids in combination with methotrexate (MTX) may improve remission rates more than MTX alone (difference range, 2.1% to 42.8%), but they did not differ significantly in disease activity in the long term (up to 5 years).
• Two-agent treatments with MTX and tumor necrosis factor (TNF) biologics or non-TNF biologics most likely yield higher treatment response rates than treatment with MTX monotherapy or any biologic monotherapy (range of American College of Rheumatology response differences, 1.2% to 25.6%).
• Rates of serious adverse events and discontinuations because of adverse events may not differ between any disease-modifying antirheumatic drugs (DMARDs).
• Insufficient information was available about treatment options for patient subgroups, such as disease activity, prior therapy, demographics, and the presence of other serious conditions.
• Future research should address the (1) assessment of long-term comparative benefits and harms of DMARDs, (2) determination of treatment decisions based on disease activity severity in early RA, and (3) timing of initiation of biologic medications.