Optimizing combination chemotherapy for rheumatoid arthritis.

A potential approach toward rational decision making when using combinations of DMARDs has been presented. This approach combines knowledge of DMARD mechanisms of action, kinetics, and toxicities to look for "nonoverlapping" combinations. When using this approach to predict responses and comparing them to studies that have been done, some encouraging results were obtained. Nevertheless, as exemplified by the combination of D-penicillamine and hydroxychloroquine, this approach is not infallible. The use of refinements of such rational choices, however, should be continued in an effort to improve the chances of success and decrease the costs of testing drug combinations.