This review corroborates previous understanding that AD burden is high for both society and healthcare providers. Limitations regarding study heterogeneity restricted conclusions; further research is required. Stakeholders could benefit from new healthcare strategies addressing both epidemiological and economic aspects of AD.
IntroductionThere is argument over the benefits and risks of drugs for treating chronic musculoskeletal pain. This study compared the efficacy, safety, and tolerability of diclofenac, ibuprofen, naproxen, celecoxib, and etoricoxib for patients with pain caused by osteoarthritis (OA) or rheumatoid arthritis (RA).MethodsA systematic literature review used Medline and EMBASE to identify randomised controlled trials. Efficacy outcomes assessed included: pain relief measured by visual analogue scale (VAS); Western Ontario McMaster Universities Arthritis Index (WOMAC) VAS or WOMAC Likert scale; physical functioning measured by WOMAC VAS or Likert scale; and patient global assessment (PGA) of disease severity measured on VAS or 5-point Likert scale. Safety outcomes included: Antiplatelet Trialists’ Collaboration (APTC), major cardiovascular (CV) and major upper gastrointestinal (GI) events, and withdrawals. Data for each outcome were synthesized by a Bayesian network meta-analysis (NMA). For efficacy assessments, labelled doses for OA treatment were used for the base case while labelled doses for RA treatment were also included in the sensitivity analysis. Pooled data across dose ranges were used for safety.ResultsEfficacy, safety, and tolerability data were found for 146,524 patients in 176 studies included in the NMA. Diclofenac (150 mg/day) was likely to be more effective in alleviating pain than celecoxib (200 mg/day), naproxen (1000 mg/day), and ibuprofen (2400 mg/day), and similar to etoricoxib (60 mg/day); a lower dose of diclofenac (100 mg/day) was comparable to all other treatments in alleviating pain. Improved physical function with diclofenac (100 and 150 mg/day) was mostly comparable to all other treatments. PGA with diclofenac (100 and 150 mg/day) was likely to be more effective or comparable to all other treatments. All active treatments were similar for APTC and major CV events. Major upper GI events with diclofenac were lower compared to naproxen and ibuprofen, comparable to celecoxib, and higher than etoricoxib. Risk of withdrawal with diclofenac was lower compared to ibuprofen, similar to celecoxib and naproxen, and higher than etoricoxib.ConclusionsThe benefit-risk profile of diclofenac was comparable to other treatments used for pain relief in OA and RA; benefits and risks vary in individuals and need consideration when making treatment decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0554-0) contains supplementary material, which is available to authorized users.
Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that, if inadequately treated, often progresses to joint destruction. Currently, patients are initially treated with conventional disease- modifying anti-rheumatic drugs (DMARDs); in patients with an inadequate response (IR), biologic DMARDs are often combined with methotrexate (MTX) or other DMARDs to improve efficacy. Objectives To compare the relative efficacy and safety of abatacept versus all relevant biologic DMARDs in MTX-IR patients with RA. Methods A systematic literature review identified randomised controlled trials (RCTs) investigating the efficacy and safety of abatacept subcutaneous (sc) and intravenous (iv), adalimumab, certolizumab, etanercept, infliximab, golimumab, tocilizumab and tofacitinib, in combination with MTX. The efficacy endpoints were American College of Rheumatology (ACR) 20/50/70 response rates and disease activity score 28 joints (DAS28) remission rates (DAS28≤2.6). Safety endpoints were incidence of serious adverse events (AE), infections, and serious infections. Abatacept sc and iv were compared to tocilizumab and the combined group of anti-TNFs (adalimumab, certolizumab, etanercept, infliximab, golimumab). Results were analysed with Bayesian hierarchical network meta-analysis (NMA) models to estimate the relative efficacy and safety effects of the biologic DMARDs. Although tofacitinib RCTS were identified in the systematic literature search, they were not included in the NMA because the study population of the three tofacitinib RCTs was different than that of the other RCTs; the majority of the patients in the tofacitinib RCTs were previously exposed to biologic DMARDs, while the patients in the other RCTs were naive to biologic DMARDs. Results The search was performed in October 2013. A total of 21 RCTs were included. Results indicate that abatacept sc has similar ACR20/50/70 response rates and DAS28 remission rates compared to other biologic DMARDs after 24 weeks of treatment (Table 1). Similar efficacy results were found for abatacept iv (data not shown). Abatacept sc seems to have slightly better safety in comparison to tocilizumab and the combined anti-TNFs in terms of incidence of infections, serious infections, and serious AE (Table 1); however, none of these differences were statistically significant. Similar results were found when comparing abatacept iv with tocilizumab and the combined anti-TNFs (data not shown). Table 1. Odds ratios (OR) and 95% credible intervals Abatacept sc versus ACR 20 ACR 50 ACR 70 DAS28<2.6 No infection* No serious infection* No serious AE* Tocilizumab 1.12 (0.91; 1.49) 1.03 (0.86; 1.26) 0.98 (0.70; 1.22) 0.82 (0.28; 1.10) 0.96 (0.68; 1.20) 1.51 (0.76; 4.26) 1.11 (0.73; 1.83) Combined anti-TNFs 0.96 (0.78; 1.13) 1.01 (0.87; 1.17) 0.98 (0.79; 1.16) 0.94 (0.73; 1.13) 1.06 (0.88; 1.32) 1.54 (0.85; 3.79) 1.25 (0.89; 1.95) *Modelled as the odds of not having an infection, serious infection or serious AE. Conclusions Both abatacept sc and iv showed ...
Objectives: To perform pharmacoeconomic analysis of golimumab (GOL) vs adalimumab (ADA) and infiliximab (INF) for rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PA) in Russia MethOds: Indirect comparison demonstrated that compared drugs have similar efficacy and safety. Costminimization analysis was performed to compare the cost for 1-year treatment with GOL, ADA and INF in doses according to the approved recommendations. Expected cost for treating all eligible patients with RA, AS and PA with TNF-α -inhibitors in Russia were calculated in a model, assuming that INF is used in the 1 st line therapy during one year and ADA or GOL in the 2d line therapy during the 2d year. Number of patients to be treated with TNF-α -inhibitors was calculated based on state statistical data and data on the percentage of patients who do not respond to therapy with synthetic disease-modifying antirheumatic drugs (DMARDs) and first-line biologic DMARDs from clinical trials. Results: INF dosing regimen is different for RA and other rheumatic diseases, 1 year treatment with INF costs € 16,212 for RA and € 24,319 for AS and PA. GOL and ADA have the same dosing regimen for all rheumatic diseases and costs € 16,544 and € 24,243 per year correspondingly. If all eligible patients with rheumatic diseases in Russia receive biologic DMARDs when necessary, treatment with GOL in the 2d line is less expensive than ADA, difference in costs is € 89,062,427 (for all eligible patients per year). It allows treating additional 4959 patients RA, 278 AS patients and 147 PA patients per year. cOnclusiOns: GOL is cost-saving vs ADA for the 2d line therapy of rheumatic diseases in Russia. 1-year treatment with GOL is less expensive that INF for AS and PA and may be considered as the 1 st line option.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.