sulphasalazine + hydroxychloroquine or prednisolone

Sulphasalazine + hydroxychloroquine or prednisolone is a combination treatment regimen used as the Active Conventional Therapy (ACT) arm in the NORD-STAR and CO-STAR Phase 4 clinical trials for early rheumatoid arthritis. Sponsored by the Karolinska Institutet, the regimen consists of a methotrexate backbone (25 mg/week) combined with either a triple therapy of sulphasalazine (2 g/day) and hydroxychloroquine (35 mg/kg/week) with mandatory intra-articular glucocorticoid injections, or a combination of methotrexate and oral prednisolone (tapered from 20 mg/day). The components are conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and a corticosteroid. Sulphasalazine acts as an anti-inflammatory agent targeting folate metabolism and NF-κB pathways, hydroxychloroquine targets toll-like receptor signaling and lysosomal function, and prednisolone is a glucocorticoid receptor agonist.

Other names

Active Conventional TherapyACT armNORD-STAR ACT regimen