The Resource Drug therapy for early rheumatoid arthritis : a systematic review update, investigators, Katrina E. Donahue, Gerald Gartlehner, Elizabeth R. Schulman, Beth Jonas, Emmanuel Coker-Schwimmer, Sheila V. Patel, Rachel Palmieri Weber, Kathleen N. Lohr, Carla Bann, Meera Viswanathan

Drug therapy for early rheumatoid arthritis : a systematic review update, investigators, Katrina E. Donahue, Gerald Gartlehner, Elizabeth R. Schulman, Beth Jonas, Emmanuel Coker-Schwimmer, Sheila V. Patel, Rachel Palmieri Weber, Kathleen N. Lohr, Carla Bann, Meera Viswanathan

Label
Drug therapy for early rheumatoid arthritis : a systematic review update
Title
Drug therapy for early rheumatoid arthritis
Title remainder
a systematic review update
Statement of responsibility
investigators, Katrina E. Donahue, Gerald Gartlehner, Elizabeth R. Schulman, Beth Jonas, Emmanuel Coker-Schwimmer, Sheila V. Patel, Rachel Palmieri Weber, Kathleen N. Lohr, Carla Bann, Meera Viswanathan
Creator
Contributor
Author
Issuing body
Sponsoring body
Subject
Genre
Language
eng
Summary
OBJECTIVES: Compare the benefits and harms of drug therapies for adults with early rheumatoid arthritis (RA) within 1 year of diagnosis, updating the findings on early RA from the 2012 review. DATA SOURCES: English-language articles identified through MEDLINE®, Cochrane Library, Embase®, International Pharmaceutical Abstracts, gray literature, the previous 2012 review, expert recommendations, reference lists of published literature, and supplemental evidence data requests from January 2011 to October 5, 2017. REVIEW METHODS: Literature was synthesized qualitatively in narrative form and summary tables within and between corticosteroids and classes of disease-modifying antirheumatic drugs (DMARDs). Additionally, combination treatment strategies were examined. We conducted network meta-analysis for five outcomes: American College of Rheumatology 50-percent improvement (ACR50), remission based on Disease Activity Score (DAS), radiographic joint damage, all discontinuations, and discontinuations due to adverse events. Eligibility for network meta-analyses required the following: (1) patients with early RA had not attempted prior treatment with methotrexate (MTX), (2) doses of treatments were within ranges approved by the Food and Drug Administration (FDA), (3) length of followup was similar, and (4) studies were double-blinded randomized controlled trials of low or medium risk of bias. RESULTS: We analyzed 49 studies: 41 RCTs and 8 observational studies reported in 124 published articles. All included studies enrolled patients with moderate to high disease activity at baseline as measured with mean or median DAS 28 scores. A combination of corticosteroids plus MTX achieved higher remission rates than with MTX monotherapy (low strength of evidence [SOE]). Combination therapy with TNF (tumor necrosis factor) or non-TNF biologics plus MTX improved disease control, remission, and functional capacity compared with monotherapy with either MTX or a biologic (low to moderate SOE). Network meta-analyses found higher ACR50 response for combination therapy of biologics plus MTX than for MTX monotherapy (range of relative risk, 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). In available data, consisting mostly of clinical trials, no significant differences emerged between any DMARDs for rates of discontinuation attributable to adverse events or serious adverse events (low SOE for adalimumab, certolizumab pegol, etanercept, infliximab, or abatacept with MTX, and moderate SOE for rituximab or tocilizumab with MTX). Data about subgroups (based on disease activity, prior therapy, demographics, and the presence of other serious conditions) were insufficient. No difference in findings were noted in MTX naïve and resistant populations. We found no studies of biosimilars for patients with early RA. CONCLUSIONS: Qualitative synthesis and network meta-analyses suggest that the combination of MTX with TNF or non-TNF biologics improves disease activity and remission when compared with biologic monotherapy or a conventional synthetic DMARD (csDMARD) monotherapy in patients with moderate to high disease activity at baseline as measured with mean or median DAS 28 scores. Overall rates of adverse events and discontinuation were similar among patients given csDMARDs, TNF biologics, and non-TNF biologics. We did not find eligible studies of biosimilars
Member of
Cataloging source
NLM
http://bibfra.me/vocab/lite/collectionName
Drug therapy for rheumatoid arthritis in adults
http://library.link/vocab/creatorName
Donahue, Katrina E
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov and Patient-Centered Outcomes Research Institute, 1828 L Street, NW, Ste. 900, Washington, DC 20036 www.pcori.org Contract No. 290-2015-00011-I. Prepared by: RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, NC
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • surveys of literature
NLM call number
WE 346
http://library.link/vocab/relatedWorkOrContributorName
  • United States
  • Effective Health Care Program (U.S.)
  • Patient-Centered Outcomes Research Institute (U.S.)
  • Research Triangle Institute-University of North Carolina Evidence-based Practice Center
Series statement
  • Comparative effectiveness review
  • AHRQ publication
  • PCORI publication
Series volume
  • number 211
  • no. 18-EHC015-EF
  • no. 2018-SR-02
http://library.link/vocab/subjectName
  • Arthritis, Rheumatoid
  • Antirheumatic Agents
  • Methotrexate
  • Comparative Effectiveness Research
  • United States
  • United States
Label
Drug therapy for early rheumatoid arthritis : a systematic review update, investigators, Katrina E. Donahue, Gerald Gartlehner, Elizabeth R. Schulman, Beth Jonas, Emmanuel Coker-Schwimmer, Sheila V. Patel, Rachel Palmieri Weber, Kathleen N. Lohr, Carla Bann, Meera Viswanathan
Instantiates
Publication
Note
"July 2018."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
txt
Content type MARC source
rdacontent
Control code
1057368395
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1057368395
Label
Drug therapy for early rheumatoid arthritis : a systematic review update, investigators, Katrina E. Donahue, Gerald Gartlehner, Elizabeth R. Schulman, Beth Jonas, Emmanuel Coker-Schwimmer, Sheila V. Patel, Rachel Palmieri Weber, Kathleen N. Lohr, Carla Bann, Meera Viswanathan
Publication
Note
"July 2018."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
txt
Content type MARC source
rdacontent
Control code
1057368395
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1057368395

Library Locations

  • St. Louis Mercantile LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • Thomas Jefferson LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • University ArchivesBorrow it
    703 Lewis Hall, Columbia, MO, 65211, US
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • Ward E Barnes Education LibraryBorrow it
    8001 Natural Bridge Rd, St. Louis, MO, 63121, US
    38.707079 -90.311355
Processing Feedback ...