Jaime Calvo Alén1, Trinidad Pérez2, Susana Romero Yuste3, Iván Ferraz-Amaro4, Juan José Alegre Sancho5, José Antonio Pinto Tasende6, Francisco Maceiras Pan7, Juan Carlos Quevedo8, M Vanesa Hernández-Hernández4, Cristina Hidalgo Calleja9, Alejandro San Martín Álvarez10, María Isabel Tevar Sánchez11, Raimon Sanmartí12. 1. Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, España. Electronic address: jcalvo@ser.es. 2. Servicio de Reumatología, Hospital de León, León, España. 3. Servicio de Reumatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España. 4. Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España. 5. Sección de Reumatología, Hospital Universitario Dr. Peset, Valencia, España. 6. Servicio de Reumatología, Complexo Hospitalario Universitario A Coruña, A Coruña, España. 7. Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Vigo, España. 8. Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España. 9. Servicio de Reumatología, Complejo Asistencial de Salamanca, Salamanca, España. 10. Sección Reumatología, Clínica HLA Vistahermosa, Alicante, España; Sección Reumatología, Hospital HLA, Denia, España. 11. Servicio de Reumatología, Hospital Vega Baja, Orihuela, España. 12. Servicio de Reumatología, Hospital Universitari Clínic, Barcelona, España.
Abstract
OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.
OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.
Keywords:
Artritis reumatoide; Combined therapy; Disease-modifying antirheumatic drugs; Fármacos modificadores de la enfermedad; Revisión sistemática de la literatura; Rheumatoid arthritis; Systematic literature review; Terapia combinada
Authors: Sun Ying; Cui Xiaomeng; Dai Xiaomin; Lin Jiang; Lv Peng; Ma Lili; Chen Rongyi; Ji Zongfei; Chen Huiyong; Jiang Lindi Journal: Ther Adv Musculoskelet Dis Date: 2020-06-02 Impact factor: 5.346
Authors: Ekta Singh; Riyaz Ali M Osmani; Rinti Banerjee; Amr Selim Abu Lila; Afrasim Moin; Khaled Almansour; Hany H Arab; Hadil Faris Alotaibi; El-Sayed Khafagy Journal: Pharmaceutics Date: 2022-02-26 Impact factor: 6.321