Comparison of etanercept and methotrexate

Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. These studies suggest that the early use of TNF- inhibitors plus MTX in RA could have significant long-term benefits in comparison with MTX alone but unfortunately this study has had limited impact on the treatment of early RA in the UK because NICE has not authorised the use of TNF- inhibitors before conventional DMARDs including MTX have been shown to be inadequate. People in the two latter combination groups had a more rapid response to treatment, and they also had less joint damage seen on x-ray at two years. In the widely quoted BeSt study people with early RA were started on treatment with MTX, sulphasalazine and other DMARDs either sequentially as single agents or in combination ; MTX combined with sulphasalazine, hydroxychloroquine and steroids, initially in high dose ; or high-dose MTX plus infliximab.