Like Dr. O’Dell, other experts say they were also surprised by the findings. “Our assumption all along was that the biologic agents would be superior and they are not,” says Jonathan S. Coblyn, MD, director of the Center for Arthritis and Joint Diseases at Brigham and Women’s Hospital in Boston.

An editorial published with the study questions whether or not the findings come too late to influence practice. Dr. Coblyn (who wasn’t involved with the study or the editorial) says not necessarily. “One study doesn’t change practice patterns of 15 years but it may be more of a signal to try triple therapy rather than going right to biologics,” he says.

The real test, Dr. Coblyn says, will be to see how patients are doing after two and three years.

Abby Abelson, MD, chair of the department of rheumatic and immunologic diseases at Cleveland Clinic in Ohio, agrees that it will be “interesting to see patients two and three years out.” She also notes that she and her colleagues end up switching a patient to another drug regimen at a rate similar to that found in the study.

Drs. Coblyn and Abelson also wonder if the findings can be replicated in a broader population. They note that about 54 percent of participants in this study were men, but RA disproportionately affects women.

Dr. Coblyn adds that compliance may become an issue with triple therapy, which requires many different pills throughout the week, compared to a weekly injection of etanercept. On the flip side, triple therapy is less expensive.

Dr. Coblyn estimates that triple therapy costs about $150 per month, while biologics can cost upward of $2,000 per month – although those numbers vary depending on insurance coverage. While this study points to a cost-effective alternative for patients, he is concerned that insurers now have grounds to require that patients try triple therapy first, before biologics.

Dr. Abelson says it would be unfortunate if that is a consequence of this study. She emphasizes that treatment needs to be individualized for each patient. “It should inform, not dictate,” she says of the study, adding that some things work better in some patients while other things work better in others.

“Every time you open the door to see a patient, you are going to see something different with this disease,” Dr. Abelson says.

But now, Dr. Abelson has an additional treatment to consider when she opens that door. “Now I can say, we do have data that in some patients triple therapy is a non-inferior alternative and offer them that,” she says.