Defining the optimal biological monotherapy in rheumatoid arthritis: a systematic review and meta-analysis of randomised trials
| العنوان: | Defining the optimal biological monotherapy in rheumatoid arthritis: a systematic review and meta-analysis of randomised trials |
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| المؤلفون: | Maria E. Suarez-Almazor, Anna Dossing, Tove Lorenzen, Simon Tarp, Michael Sejer Hansen, Jasvinder A. Singh, Mikkel Østergaard, Ernest Choy, Daniel E. Furst, Maarten Boers, Robin Christensen, Lars Erik Kristensen, Henning Bliddal |
| المساهمون: | Epidemiology and Data Science, APH - Methodology |
| المصدر: | Tarp, S, Furst, D E, Dossing, A, Ostergaard, M, Lorenzen, T, Hansen, M S, Singh, J A, Choy, E H, Boers, M, Suarez-Almazor, M E, Kristensen, L E, Bliddal, H & Christensen, R 2017, ' Defining the optimal biological monotherapy in rheumatoid arthritis : A systematic review and meta-analysis of randomised trials ', Seminars in Arthritis and Rheumatism, vol. 46, no. 6, pp. 699-708 . https://doi.org/10.1016/j.semarthrit.2016.09.003Test Tarp, S, Furst, D E, Dossing, A, Østergaard, M, Lorenzen, T, Hansen, M S, Singh, J A, Choy, E H, Boers, M, Suarez-Almazor, M E, Kristensen, L E, Bliddal, H & Christensen, R 2017, ' Defining the optimal biological monotherapy in rheumatoid arthritis : A systematic review and meta-analysis of randomised trials ', Seminars in Arthritis and Rheumatism, vol. 46, no. 6, pp. 699-708 . https://doi.org/10.1016/j.semarthrit.2016.09.003Test Seminars in Arthritis and Rheumatism, 46(6), 699-708. W.B. Saunders Ltd |
| بيانات النشر: | Elsevier, 2016. |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | musculoskeletal diseases, medicine.medical_specialty, JAK INHIBITOR, DISEASE-ACTIVITY, RECOMMENDATIONS, Etanercept, Arthritis, Rheumatoid, Biological agents, DOUBLE-BLIND, INADEQUATE RESPONSE, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, Rheumatology, immune system diseases, Internal medicine, TOCILIZUMAB MONOTHERAPY, medicine, Adalimumab, Humans, 030212 general & internal medicine, Rheumatoid arthritis, AGENTS, skin and connective tissue diseases, Randomized Controlled Trials as Topic, 030203 arthritis & rheumatology, Anakinra, Biological Products, business.industry, Abatacept, medicine.disease, R1, Infliximab, METHOTREXATE, Meta-analysis, ADALIMUMAB MONOTHERAPY, Anesthesiology and Pain Medicine, Treatment Outcome, chemistry, Antirheumatic Agents, Systematic review, MODIFYING ANTIRHEUMATIC DRUGS, Physical therapy, business, medicine.drug |
| الوصف: | Objectives: To summarize and compare the benefits and harms of biological agents used as monotherapy for rheumatoid arthritis (RA) in order to inform decisions for patients who are intolerant to conventional DMARD therapy.Methods: We searched MEDLINE, EMBASE, CENTRAL, and other sources for randomised trials that compared biological monotherapy with methotrexate, placebo, or other biological monotherapies. Primary outcomes were ACR50 and the number of patients who discontinued due to adverse events. Our network meta-analysis was based on mixed-effects logistic regression, including both direct and indirect comparisons of the treatment effects, while preserving the randomised comparisons within each trial. PROSPERO identifier: CRD42012002800.Results: The analysis comprises 28 trials (8602 patients), including all nine biological agents approved for RA. Eight trials included "DMARD-naive", and 20 "DMARD-Inadequate responder" (DMARD-IR) patients. All agents except anakinra and infliximab were superior (p 0.52). However, because rituximab was evaluated in just 40 patients, our confidence in the estimates is limited. When including only DMARD-IR trials, the same statistical pattern emerged; in addition etanercept and tocilizumab were superior to abatacept. At recommended doses, both etanercept and tocilizumab were superior to adalimumab and certolizumab. No statistically significant differences among biological agents were found with respect to discontinuation due to adverse events (p > 0.068).Conclusions: Evidence from randomised trials suggests that most biological agents are effective as mono therapy. Although our confidence in the estimates is limited, etanercept or tocilizumab may be the optimal choice for most patients who need treatment with biological monotherapy. However, given our limited confidence in the estimates including possibility of bias, it is appropriate to strongly weight patients' preferences and values in the final treatment choice. (C) 2017 Elsevier Inc. All rights reserved. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 0049-0172 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fa0c7d6c9f90fafa705eacbfa7d8def3Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....fa0c7d6c9f90fafa705eacbfa7d8def3 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00490172 |
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