Public Release: 

Intensive initial therapy with triple DMARDs improves functional ability in early RA

Aggressive therapy shows some early benefit over monotherapy and similar rate of drug-free remission

European League Against Rheumatism

Rome, Italy, 10 June 2015: The results of the tREACH trial presented today at the European League Against Rheumatism Annual Congress (EULAR 2015) Press Conference showed that initial therapy with combination DMARDs significantly improves measures of disease activity and functional ability in patients with early rheumatoid arthritis (RA). These findings suggest that an initial treatment regimen of methotrexate, sulfasalazine and hydroxychloroquine could provide significant patient benefits over monotherapy (methotrexate alone).

"Many trials have shown that early and intensive treatment can induce remission and prevent joint damage in patients with rheumatoid arthritis, yet often a step-wise approach of escalating treatment is preferred," said lead author Dr. Angelique Weel of the Department of Rheumatology, Maasstad Hospital, Netherlands. "Our data showed an earlier decrease in disease severity and improvements in functional ability in the combination-therapy groups compared to monotherapy, adding to the evidence base for an intensive treatment approach early on. And with significant numbers of patients achieving drug-free remission using less expensive biologicals during the first two years of therapy, these data should alleviate concerns regarding the need for long-term aggressive therapy."

Functional ability was measured using the Health Assessment Questionnaire (HAQ), a good predictor of future disability and cost. After just three months, improvements in HAQ score were significantly greater in the triple DMARD induction therapy group, and remained significant throughout the two years, irrespective of disease activity. Joint damage progression seen on X-rays was minimal and similar for both groups.

281 RA patients were randomised to methotrexate, sulfasalazine and hydroxychloroquine with bridging glucocorticoid or methotrexate alone (with glucocorticoid). After two years, the percentage of patients attaining a DAS44 score (composite score of disease activity) less than 1.6 at two consecutive time points (sustained remission) was similar for those patients started on triple DMARD therapy (51%) vs. monotherapy (47%). Exacerbation of symptoms (prevalence of flares) after tapering medication was similar between the combination and monotherapy groups.


Abstract Number: OP0030


For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR congress Press Office in Room 5B of Fiera Roma during EULAR 2015 or on:
Onsite tel: +44 (0) 7738 890 799 / +44 (0) 20 7331 5442
Twitter: @EULAR_Press
Youtube: Eular Pressoffice


The European League Against Rheumatism (EULAR) is an umbrella organisation which represents scientific societies, health professional associations and organisations for people with rheumatic diseases throughout Europe.

EULAR aims to promote, stimulate and support the research, prevention, and treatment of rheumatic diseases and the rehabilitation of those it affects.

With 45 scientific member societies, 35 People with Arthritis and Rheumatism in Europe (PARE) organisations, 19 health professionals associations and 21 corporate members, EULAR highlights the importance of combating rheumatic diseases through both medical means and patient care.

EULAR 2015 is set to be the biggest rheumatology event in Europe with around 14,000 scientists, physicians, allied health professionals and related audiences in attendance from more than 120 countries. Over the course of the congress there will be some 300 oral and just under 2,000 poster abstract presentations, more than 150 sessions, 400 lectures, 40 poster tours and 350 invited speakers.

To find out more about the activities of EULAR, visit:

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.