Is non-biological treatment of rheumatoid arthritis as good as biologics?

Table 1 RCTs comparing outcomes in rheumatoid arthritis

Trial	Arms	No. of	Mean/median disease	Outcome	Outcome
		patients	duration at presentation	assessment at	Clinical	Functional (change in HAQ)	Radiological
TICORA[3]	Intensive Conventional	55 55	Approximately 20 mo	18 mo	EGR 82% vs 45% ER 64% vs 16% ACR70 71% vs 18%	NA	Median change TSS 4.5 vs 8.5
CAMERA[4]	Intensive	151	< 1 yr	1 yr	Remission for 3 mo 35% vs 14% ACR50 58% vs 43%	NS	NS
	Conventional	148		2 yr	Remission for 3 mo 50% vs 37% ACR50 43% vs 45%
FINRACO[5]	SSZ + MTX + HCQ	87	Approximately 8 mo	2 yr	ACR remission 37% vs 18%	NS	Increase Larsen score 4 vs 12
	SSZ	91			ACR50 71% vs 58%
NEO-RACO[20]	SSZ + MTX + HCQ + IFX	50	4 mo	5 yr	Remission-ACR: 60% vs 61%	NA	Change in SHS NS
	SSZ + MTX + HCQ + Placebo	49			DAS28: 84% vs 89%
BEST[8]	Seq Monotherapy	126	2 wk	1 yr	LDA 53%; 64%; 71%; 74%	0.7; 0.7; 0.9; 0.8	Change in SHS 2; 2.5; 1; 0.5
	Step up	121
	MTX + SSZ + Pred	133
	MTX + IFX	128		2 yr	LDA 75%; 81%; 78%; 82%	0.7; 0.8; 0.9; 0.9	Change in SHS 2; 2; 1; 1
TEAR[10]	Immediate ETAN	244	Approximately 4 mo	2 yr	ACR20 45%-50% in all	NS	Change in TSS 0.5; 1.9; 0.7; 1.4
	Immediate triple	132			ACR50 35%-40% in all
	Step-up ETAN	255			ACR70 10%-20% in all
	Step-up triple	124

NS: Not significant; NA: Not available; SHS: Modified sharp score; MTX: Methotrexate; SSZ: Sulfasalazine; HCQ: Hydroxychloroquine; IFX: Infliximab; ETAN: Etanercept; Pred: Prednisolone; LDA: Low disease activity; EGR: EULAR good response; ER: EULAR remission; TSS: Total sharp score; DAS: Disease activity score.