#6-07E. Rethinking First-Line Therapy: Early Biologics vs. Methotrexate in Rheumatoid Arthritis (Rheumatology, 2026)

Should conventional methotrexate remain the mandatory first-line therapy for all patients with newly diagnosed early rheumatoid arthritis? This comprehensive meta-analysis of 29 randomized controlled trials demonstrates that initial combination therapy with biologics or targeted synthetic DMARDs significantly increases early remission rates compared to methotrexate alone, particularly in patients with high baseline disease activity or seropositivity. Although significant heterogeneity in comparator regimens and acute-phase reactant sensitivity warrant cautious appraisal, these findings suggest moving beyond a strict methotrexate-first strategy to enable personalized, early intensive treatment for high-risk patients.

Citation: Russell MD, Chan CJ, Sasitharan A, et al. First-line biologic and targeted synthetic DMARDs versus methotrexate in early rheumatoid arthritis: a meta-analysis of remission outcomes. Rheumatology. 2026.

DOI: 10.1093/rheumatology/keag515

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