Journal Article

Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis

Falzon, Louise, McInnes, Iain B, Dougados, Maxime, de Wit, Maarten, Sepriano, Alexandre, van Vollenhoven, Ronald, Bijlsma, Johannes W J, Landewé, Robert, Kerschbaumer, Andreas, Smolen, Josef S, van der Heijde, Désirée, Burmester, Gerd R

2020

Overview

ObjectivesTo inform the 2019 update of the European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA).MethodsA systematic literature research (SLR) to investigate the efficacy of any disease-modifying antirheumatic drug (DMARD) (conventional synthetic (cs)DMARD, biological (b) and biosimilar DMARD, targeted synthetic (ts)DMARD) or glucocorticoid (GC) therapy in patients with RA was done by searching MEDLINE, Embase and the Cochrane Library for articles published between 2016 and 8 March 2019.Results234 abstracts were selected for detailed assessment, with 136 finally included. They comprised the efficacy of bDMARDs versus placebo or other bDMARDs, efficacy of Janus kinase (JAK) inhibitors (JAKi) across different patient populations and head-to-head of different bDMARDs versus JAKi or other bDMARDs. Switching of bDMARDs to other bDMARDs or tsDMARDs, strategic trials and tapering studies of bDMARDs, csDMARDs and JAKi were assessed. The drugs evaluated included abatacept, adalimumab, ABT-122, baricitinib, certolizumab pegol, SBI-087, CNTO6785, decernotinib, etanercept, filgotinib, golimumab, GCs, GS-9876, guselkumab, hydroxychloroquine, infliximab, leflunomide, mavrilimumab, methotrexate, olokizumab, otilimab, peficitinib, rituximab, sarilumab, salazopyrine, secukinumab, sirukumab, tacrolimus, tocilizumab, tofacitinib, tregalizumab, upadacitinib, ustekinumab and vobarilizumab. The efficacy of many bDMARDs and tsDMARDs was shown. Switching to another tumour necrosis factor inhibitor (TNFi) or non-TNFi bDMARDs after TNFi treatment failure is efficacious. Tapering of DMARDs is possible in patients achieving long-standing stringent clinical remission; in patients with residual disease activity (including patients in LDA) the risk of flares is increased during the tapering. Biosimilars are non-inferior to their reference products.ConclusionThis SLR informed the task force regarding the evidence base of various therapeutic regimen for the development of the update of EULAR’s RA management recommendation.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited,BMJ Publishing Group
• Subject: anti-TNF / Antirheumatic Agents - therapeutic use / Arthritis, Rheumatoid - drug therapy / Biological products / Biological Products - therapeutic use / Biosimilar Pharmaceuticals - therapeutic use / Clinical trials / Dihydrofolate reductase / DMARDs (biologic) / DMARDs (synthetic) / Drug development / Drug Substitution / Drug therapy / Drug Therapy, Combination / Drugs / Etanercept / Glucocorticoids / Glucocorticoids - therapeutic use / Humans / Hydroxychloroquine / Immunomodulators / Immunotherapy / Infliximab / Intervention / Janus kinase / Janus Kinase Inhibitors - therapeutic use / Leflunomide / Methotrexate / Monoclonal antibodies / Patients / Randomized Controlled Trials as Topic / Remission / Rheumatism / Rheumatoid Arthritis / Rheumatology / Rituximab / Studies / Synthetic Drugs - therapeutic use / Tacrolimus / Task forces / Tumor Necrosis Factor-alpha - antagonists & inhibitors / Tumor necrosis factor-TNF / Tumor necrosis factor-α / Tumors