Most Appropriate Conventional Disease-Modifying Antirheumatic Drug to Combine With Different Advanced Therapies in Rheumatoid Arthritis: A Systematic Literature Review With Meta-Analysis.
Antirheumatic Agents
/ adverse effects
Arthritis, Rheumatoid
/ diagnosis
Biological Products
/ adverse effects
Drug Therapy, Combination
Humans
Janus Kinase Inhibitors
/ therapeutic use
Methotrexate
/ therapeutic use
Molecular Targeted Therapy
Time Factors
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
04
06
2019
accepted:
17
03
2020
pubmed:
28
3
2020
medline:
10
8
2021
entrez:
28
3
2020
Statut:
ppublish
Résumé
In rheumatoid arthritis, the association between advanced therapies (including biologic disease-modifying antirheumatic drugs [DMARDs] and targeted synthetic DMARDs) and methotrexate (MTX) is recommended by international societies. When MTX cannot be used, other conventional synthetic DMARDs (csDMARDs) may be proposed. We aimed to compare the safety and efficacy of MTX and non-MTX csDMARDs in combination with advanced therapies. We systematically searched the literature for studies comparing the effectiveness, retention rate, and safety of MTX versus non-MTX csDMARDs (leflunomide or others) in combination with tumor necrosis factor inhibitors (TNFi), abatacept, rituximab, tocilizumab, and JAK inhibitors. Meta-analysis was performed with RevMan, using an inverse variance approach with fixed or random-effects models. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated. The literature search revealed 3,842 articles; 41 studies were included for the systematic literature review and 21 for the meta-analysis: 13 with TNFi, 3 with abatacept, and 5 with rituximab. For TNFi, the European Alliance of Associations for Rheumatology (EULAR) response at 6 months was lower for patients receiving non-MTX csDMARDs than for those using MTX (RR 0.93 [95% CI 0.87, 1.0], P = 0.04; n = 3,843; I The different csDMARDs seem safe and efficient to combine with advanced therapies in RA patients. Although MTX seems slightly superior to other csDMARDs in combination with TNFi, leflunomide might be superior to MTX in combination with rituximab.
Substances chimiques
Antirheumatic Agents
0
Biological Products
0
Janus Kinase Inhibitors
0
Tumor Necrosis Factor Inhibitors
0
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
873-884Informations de copyright
© 2020, American College of Rheumatology.
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