Abstract
BackgroundComparative effectiveness of early rheumatoid arthritis (RA) treatments remains uncertain.PurposeCompare benefits and harms of biologic drug therapies for adults with early RA within 1 year of diagnosis.Data SourcesEnglish language articles from the 2012 review to October 2017 identified through MEDLINE, Cochrane Library and International Pharmaceutical s, gray literature, expert recommendations, reference lists of published literature, and supplemental evidence data requests.Study SelectionTwo persons independently selected studies based on predefined inclusion criteria.Data ExtractionOne reviewer extracted data; a second reviewer checked accuracy. Two independent reviewers assigned risk of bias ratings.Data SynthesisWe identified 22 eligible studies with 9934 participants. Combination therapy with tumor necrosis factor (TNF) or non-TNF biologics plus methotrexate (MTX) improved disease control, remission, and functional capacity compared with monotherapy of either MTX or a biologic. Network meta-analyses found higher ACR50 response (50% improvement) for combination therapy of biologic plus MTX than for MTX monotherapy (relative risk range 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). No significant differences emerged between treatment discontinuation rates because of adverse events or serious adverse events. Subgroup data (disease activity, prior therapy, demographics, serious conditions) were limited.LimitationsTrials enrolled almost exclusively selected populations with high disease activity. Network meta-analyses were derived from indirect comparisons relative to MTX due to the dearth of head-to-head studies comparing interventions. No eligible data on biosimilars were found.ConclusionsQualitative and network meta-analyses suggest that the combination of MTX with TNF or non-TNF biologics reduces disease activity and improves remission when compared with MTX monotherapy. Overall adverse event and discontinuation rates were similar between treatment groups.RegistrationPROSPERO (available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017079260).
Highlights
Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disease affecting more than 1 million Americans and characterized by synovial inflammation, which can lead to progressive bone erosion, joint damage, and disability.[1]
We considered network meta-analyses (NWMA) for American College of Rheumatology 50% improvement (ACR50), Disease Activity Score (DAS) remission, radiographic joint damage, all study discontinuations, and discontinuations attributed to adverse events
No study examined ETN plus MTX compared with ETN monotherapy directly; NWMA favored the combination of ETN plus MTX over ETN monotherapy for higher ACR50 response (RR, 1.57; 95% CI, 1.23 to 2.02) (Fig. 4)
Summary
Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disease affecting more than 1 million Americans and characterized by synovial inflammation, which can lead to progressive bone erosion, joint damage, and disability.[1]. Experts and guideline groups support using csDMARDs, often methotrexate (MTX), as the first line-therapy.[3, 4] Despite recommendations, advocates encourage early biologic use to induce remission.[5, 6]. Combination therapy with tumor necrosis factor (TNF) or non-TNF biologics plus methotrexate (MTX) improved disease control, remission, and functional capacity compared with monotherapy of either MTX or a biologic. Network meta-analyses found higher ACR50 response (50% improvement) for combination therapy of biologic plus MTX than for MTX monotherapy (relative risk range 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). CONCLUSIONS: Qualitative and network meta-analyses suggest that the combination of MTX with TNF or non-
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
