A study found that older drugs, such as disease-modifying antirheumatic drugs, or DMARDs, used to treat rheumatoid arthritis, or RA, can be as effective at slowing joint damage as newer, pricier biologic medications.

The study’s researchers acknowledge these findings might be met with skepticism because many believe biologics to be superior.

“Since the appearance of biologic agents in the beginning of this century it has been a general position that these were much better in the treatment of rheumatoid arthritis than the well-known classical and cheap antirheumatic drugs or DMARDs,” says lead author Niels Graudal, MD, a clinical rheumatologist and researcher at Copenhagen University Hospital in Denmark. “I think our results are very surprising.”

Traditional DMARDs include agents like cyclosporine and methotrexate, which have been used for decades to slow the progression of RA, though doctors aren’t always sure why they work. Corticosteroids are hormones that fight inflammation, and biologic agents, which include medications like etanercept, or Enbrel, adalimumab, or Humira, and infliximab, or Remicade, block the chemical signals that spur inflammation.

In Arthritis & Rheumatism, Dr. Graudal and his colleagues reviewed 70 previously published trials that measured the effectiveness of different combinations of RA drugs.

They found that treatment with one DMARD or corticosteroid reduced X-ray evidence of joint destruction between 50 and 65 percent compared to a placebo.

Compared to treatment with a single DMARD alone, joint destruction was reduced between 50 and 84 percent when a corticosteroid or a biologic agent was added.

Two DMARDs given with corticosteroids proved to be as effective as a biologic given with methotrexate.

“The big news is that even a single DMARD is able to stop joint destruction in many patients and on the average, inhibits joint destruction 65 percent compared with no treatment,” Dr. Graudal says. “With a combination of two to three DMARDs and a low dose corticosteroid, you can obtain the same inhibition of joint destruction as you can with a biologic agent plus methotrexate.”