Biologics are more expensive than other medications because they are genetically engineered. Researchers say while they can be very helpful to patients who don’t respond to DMARDs, they believe their study shows there are equally affordable options for most other patients.

Dr. Graudal says he hopes the study findings reassure doctors and patients that are giving and getting a more traditional course of medicine.

“Many rheumatologists who treat their patients with old fashioned DMARDs might have been nagged by a feeling that a better biologic treatment was withheld from their patients for economical reasons only,” Dr. Graudal says.

David Pisetsky, MD, PhD, a professor of Medicine and Immunology at Duke University Medical Center in Durham, N.C., agrees with the study’s findings.

“While biological agents such as TNF blockers are effective in the treatment of rheumatoid arthritis, other drugs as well as drug combinations can produce similar benefits,” Dr. Pisetsky says. “The important goal of therapy is to reduce disease activity and hopefully achieve remission. This goal can be accomplished in many different ways, with the use of biologicals one of many approaches that are currently available.”

But Daniel E. Furst, MD, a professor of rheumatology at the University of California, Los Angeles, says while they might not have been included in this research, there are studies that show biologics improve radiographs more than non biologics. And he says the numbers in this study just don’t add up for him.

“They say that there is a relative effect of 50 to 65 percent using a DMARD versus a placebo. And then the next sentence they say if you use a DMARD and biologics you get an additional 50 to 80 percent improvement compared to a single DMARD. So their conclusion that there is no difference between single and multiple DMARDS doesn’t hold up,” Dr. Furst says. “It’s hard for me to understand their conclusion which says that everything is the same.”