ciclosporin + infliximab + methotrexate + prednisolone

This is a combination therapy consisting of four immunosuppressive and anti-inflammatory agents used primarily for treating refractory rheumatoid arthritis. The combination includes ciclosporin (a calcineurin inhibitor), infliximab (a TNF-alpha inhibitor), methotrexate (a disease-modifying anti-rheumatic drug), and prednisolone (a corticosteroid). This combination may be used when patients cannot tolerate methotrexate alone or when disease activity remains high despite conventional therapy. Studies suggest that ciclosporin may be an alternative disease-modifying drug to be used in combination with infliximab in patients with refractory RA who cannot tolerate methotrexate.