A systematic comparison of combination DMARD therapy and tumour necrosis inhibitor therapy with methotrexate in patients with early rheumatoid arthritis.

Rheumatology
Margaret H Y MaDavid L Scott

Abstract

We examined how combination DMARD therapies and TNF inhibitors therapies plus MTX (TNF/MTX) affect clinical and radiological outcomes compared with MTX monotherapy in early RA. We systematically searched EMBASE, PubMed and Ovid Medline for randomized controlled trials (RCTs) of combination therapy in early RA. We evaluated ACR responses, withdrawals for inefficacy and toxicity, HAQ and radiographic progression. Meta-analysis using Review Manager evaluated random effects odds ratios (ORs) and random effects weighted mean differences (WMDs) between treatments. A preliminary search identified 2029 citations; 15 were relevant RCTs (4200 randomized patients). Patients with active disease were enrolled. Compared with MTX monotherapy, both combination DMARDs and TNF/MTX increased ACR20-70 responses (OR 1.64-2.02 and 2.03-2.30, respectively), reduced withdrawals for inefficacy (OR 0.52 and 0.29), reduced HAQ (WMD -0.17 and -0.16) and reduced annual X-ray progression (WMD -1.20 and -0.84%). DMARD combinations increased withdrawals for toxicity (OR 2.69; there was no difference with TNF/MTX). The only head-to-head RCT showed comparable efficacy for combination DMARDs and TNF/MTX combinations. In early active RA, both combination DMARDs a...Continue Reading

References

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Citations

Jan 11, 2012·Nature Reviews. Rheumatology·Alberto Martini
May 8, 2010·Arthritis Research & Therapy·David L Scott, Gabrielle Kingsley
Jan 5, 2012·Nihon Rinshō Men'eki Gakkai kaishi = Japanese journal of clinical immunology·Yuki NankeShigeru Kotake
Mar 6, 2013·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Jasvinder A Singh
Dec 24, 2010·Hand Clinics·J Michelle Kahlenberg, David A Fox
Sep 28, 2010·Journal of Cellular Biochemistry·France VaillancourtMohamed Benderdour
Aug 7, 2016·Therapeutic Advances in Musculoskeletal Disease·Francisco EspinozaYves-Marie Pers
Jan 15, 2015·British Journal of Hospital Medicine·A Mian, D L Scott
Dec 6, 2012·The American Journal of Gastroenterology·Laurent Peyrin-BirouletWilliam J Sandborn
Oct 26, 2012·Arthritis Care & Research·Jasvinder A SinghDaniel Furst
Jul 19, 2011·The Journal of Rheumatology·Jacob KarshUNKNOWN Canadian Rheumatology Research Consortium
Jan 17, 2012·The Journal of Rheumatology·Margaret H Y MaDavid L Scott
Nov 3, 2010·Nature Reviews. Rheumatology·David L Scott, Anna Kowalczyk
Jan 27, 2011·Zeitschrift für Rheumatologie·K Krüger
Dec 15, 2011·Clinical Pharmacology and Therapeutics·D L Scott
Jun 7, 2020·Zeitschrift für Rheumatologie·M SchneiderC Specker

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