Oct 1, 1990

The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses

Arthritis and Rheumatism
D T FelsonR F Meenan

Abstract

We performed 2 metaanalyses of placebo-controlled and comparative clinical trials to examine the relative efficacy and toxicity of methotrexate (MTX), injectable gold, D-penicillamine (DP), sulfasalazine (SSZ), auranofin (AUR), and antimalarial drugs, the second-line drugs most commonly used to treat rheumatoid arthritis (RA). For the efficacy study, we applied a set of inclusion criteria and focused on trials which provided information on tender joint count, erythrocyte sedimentation rate, or grip strength. We found 66 clinical trials that contained 117 treatment groups of interest, and for each drug, we combined the treatment groups. For each outcome, results showed that AUR tended to be weaker than other second-line drugs. The results of the 3 outcome measures were synthesized into a composite measure of outcomes, and AUR was significantly weaker than MTX (P = 0.006), injectable gold (P less than 0.0001), DP (P less than 0.0001), and SSZ (P = 0.009) and was slightly, but not significantly, weaker than antimalarial agents (P = 0.11). We also found heterogeneity among antimalarial agents, in that patients treated with chloroquine did better than those treated with hydroxychloroquine. We found little difference in efficacy betw...Continue Reading

  • References17
  • Citations191

Mentioned in this Paper

Meta Analysis (Statistical Procedure)
Penicillamine
Hydroxychloroquine
Erythrocyte Sedimentation Rate Measurement
Sulfasalazin medac
Chloroquine
Rheumatoid Arthritis
Metalcaptase
Methotrexate
Methotrexate, (DL)-Isomer

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