Our study also shows that a targeted smallmolecule
JAK inhibitor can be more effective
clinically, functionally, and radiographically than
methotrexate in patients with rheumatoid arthritis
who have not previously received methotrexate.
Combinations of nonbiologic or biologic
DMARDs with methotrexate have been shown
to be superior to methotrexate alone.7,8,27-29 Two
prior articles attempted to show the superiority
of a biologic DMARD administered as monotherapy
over methotrexate.27,30 In the Early Rheumatoid
Arthritis trial of etanercept versus methotrexate,
in which a significantly greater proportion
of patients who received etanercept at a dose
of 25 mg twice weekly had ACR 20, ACR 50,
or ACR 70 responses, as compared with patients
who received methotrexate within the
first 6 months, the differences were not significant
at year 1 and thereafter (except for the
ACR 20 response at year 2). The change from
baseline in the modified total Sharp score at
year 1 and year 2, however, was significantly
smaller in the group of patients who received
etanercept at a dose of 25 mg than in the group
of patients who received methotrexate.27