Katerina Chatzidionysiou1, Sharzad Emamikia1, Jackie Nam2, Sofia Ramiro3, Josef Smolen4, Désirée van der Heijde3, Maxime Dougados5, Johannes Bijlsma6, Gerd Burmester7, Marieke Scholte8,9, Ronald van Vollenhoven1,10, Robert Landewé10. 1. Karolinska Institute, Stockholm, Sweden. 2. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. 3. LUMC, Leiden, The Netherlands. 4. Medical University of Vienna, Vienna, Austria. 5. Paris Descartes University, Paris, France. 6. Utrecht University Medical Center, Utrecht, The Netherlands. 7. Charité University Hospital, Berlin, Germany. 8. Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. 9. EULAR Standing Committee of People with Arthritis/Rheumatism in Europe. 10. Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: To perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA). METHODS: An SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials. RESULTS: For GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations. CONCLUSIONS: Addition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVES: To perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA). METHODS: An SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials. RESULTS: For GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations. CONCLUSIONS: Addition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: C Fiehn; J Holle; C Iking-Konert; J Leipe; C Weseloh; M Frerix; R Alten; F Behrens; C Baerwald; J Braun; H Burkhardt; G Burmester; J Detert; M Gaubitz; A Gause; E Gromnica-Ihle; H Kellner; A Krause; J Kuipers; H-M Lorenz; U Müller-Ladner; M Nothacker; H Nüsslein; A Rubbert-Roth; M Schneider; H Schulze-Koops; S Seitz; H Sitter; C Specker; H-P Tony; S Wassenberg; J Wollenhaupt; K Krüger Journal: Z Rheumatol Date: 2018-08 Impact factor: 1.372
Authors: Carlos A Trindade-da-Silva; Juliana T Clemente-Napimoga; Henrique B Abdalla; Sergio Marcolino Rosa; Carlos Ueira-Vieira; Christophe Morisseau; Waldiceu A Verri; Victor Angelo Martins Montalli; Bruce D Hammock; Marcelo H Napimoga Journal: FASEB J Date: 2020-05-13 Impact factor: 5.191