Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update

Stoffer, Michaela; Schoels, Monika; Smolen, Josef S; Aletaha, Daniel; Breedveld, Ferdinand C.; Burmester, Gerd R; Bykerk, Vivian P.; Dougados, Maxime; Emery, Paul; Haraoui, Boulos; Gómez-Reino, Juan J.; Kvien, Tore K; Nash, Peter; Navarro-Compán, Victoria; Scholte-Voshaar, Marieke; Vollenhoven, Ronald van; Heijde, Desirée van der; Stamm, Tanja

doi:10.1136/annrheumdis-2015-207526

Cited by 293 publications

(160 citation statements)

References 30 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…The Knevel et al 82 review also reported no particular benefit of TTT among patients with established RA, but an overall benefit of TTT among early RA patients. It is unclear whether or not the reviews by Schoels et al, 23 Stoffer et al 79 and Knevel et al 82 reported on all outcomes reported in all included studies; the current review provides an explicit and comprehensive overview of all measured outcomes. All five previous reviews examined data from RCTs and non-randomised studies together, whereas the current review focused on RCTs only, to reduce the possibility of selection bias.…”

Section: -78mentioning

confidence: 99%

“…The systematic reviews by Schoels et al 23 (initial review) and Stoffer et al 79 (update of the Schoels et al review), designed to inform the international task force recommendations for treating to target, 17,18 both concluded that TTT was more effective than usual care. Similarly, Jurgens et al 21 examined the effectiveness of TTT on remission rates and found results in favour of TTT, Schipper et al 80 compared the effectiveness of TTT with usual care on mean change in DAS28 and found TTT to be more effective than usual care and Bakker et al 81 found evidence of the effectiveness of TTT in terms of remission, but did not synthesise the evidence (findings were reported individually by study).…”

Section: -78mentioning

confidence: 99%

See 1 more Smart Citation

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

Wailoo

Everson-Hock

Stevenson

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

Background Treat to target (TTT) is a broad concept for treating patients with rheumatoid arthritis (RA). It involves setting a treatment target, usually remission or low disease activity (LDA). This is often combined with frequent patient assessment and intensive and rapidly adjusted drug treatment, sometimes based on a formal protocol. Objective To investigate the clinical effectiveness and cost-effectiveness of TTT compared with routine care. Data sources Databases including EMBASE and MEDLINE were searched from 2008 to August 2016. Review methods A systematic review of clinical effectiveness was conducted. Studies were grouped according to comparisons made: (1) TTT compared with usual care, (2) different targets and (3) different treatment protocols. Trials were subgrouped by early or established disease populations. Study heterogeneity precluded meta-analyses. Narrative synthesis was undertaken for the first two comparisons, but was not feasible for the third. A systematic review of cost-effectiveness was also undertaken. No model was constructed as a result of the heterogeneity among studies identified in the clinical effectiveness review. Instead, conclusions were drawn on the cost-effectiveness of TTT from papers relating to these studies. Results Sixteen clinical effectiveness studies were included. They differed in terms of treatment target, treatment protocol (where one existed) and patient visit frequency. For several outcomes, mixed results or evidence of no difference between TTT and conventional care was found. In early disease, two studies found that TTT resulted in favourable remission rates, although the findings of one study were not statistically significant. In established disease, two studies showed that TTT may be beneficial in terms of LDA at 6 months, although, again, in one case the finding was not statistically significant. The TICORA (TIght COntrol for RA) trial found evidence of lower remission rates for TTT in a mixed population. Two studies reported cost-effectiveness: in one, TTT dominated usual care; in the other, step-up combination treatments were shown to be cost-effective. In 5 of the 16 studies included the clinical effectiveness review, no cost-effectiveness conclusion could be reached, and in one study no conclusion could be drawn in the case of patients denoted low risk. In the remaining 10 studies, and among patients denoted high risk in one study, cost-effectiveness was inferred. In most cases TTT is likely to be cost-effective, except where biological treatment in early disease is used initially. No conclusions could be drawn for established disease. Limitations TTT refers not to a single concept, but to a range of broad approaches. Evidence reflects this. Studies exhibit substantial heterogeneity, which hinders evidence synthesis. Many included studies are at risk of bias. Future work Future studies comparing TTT with usual care must link to existing evidence. A consistent definition of remission in studies is required. There may be value in studies to establish the importance of different elements of TTT (the setting of a target, the intensive use of drug treatments and protocols pertaining to those drugs and the frequent assessment of patients). Conclusion In early RA and studies of mixed early and established RA populations, evidence suggests that TTT improves remission rates. In established disease, TTT may lead to improved rates of LDA. It remains unclear which element(s) of TTT (the target, treatment protocols or increased frequency of patient visits) drive these outcomes. Future trials comparing TTT with usual care and/or different TTT targets should use outcomes comparable with existing literature. Remission, defined in a consistent manner, should be the target of choice of future studies. Study registration This study is registered as PROSPERO CRD42015017336. Funding The National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: -78mentioning

confidence: 99%

Section: -78mentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

Wailoo

Everson-Hock

Stevenson

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…Em vista disso, um dos principais objetivos da terapia atual é controlar rigorosamente o processo inflamatório, a fim de reduzir a atividade da doença e suas implicações [7,8].…”

Section: Introductionunclassified

Anemia e índices de atividade de doença em mulheres com artrite reumatoide

Scheffel¹,

Prado²,

Staub³

et al. 2018

Sci Med

View full text Add to dashboard Cite

Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To evaluate disease activity indexes in female patients with rheumatoid arthritis, Anemic and Non-anemic, correlating them with hemoglobin levels. METHODS: A cross-sectional study involved women with rheumatoid arthritis classified into two groups: 1) Anemic (hemoglobin < 12 g/dL) and 2) Non-anemic. Disease activity was measured by Disease Activity Index (DAS28), using different inflammatory markers: Erythrocyte Sedimentation Rate (ESR) and C-reative Protein (CRP). This score also uses the number of swollen and painful joints and an overall assessment of the disease on Visual Analogue Scale (VAS). An assessment of functional capacity by the Health Assessment Questionnaire (HAQ) was also performed. The statistic used Student's t-Test, Mann-Whitney, Wilcoxon, Fisher, likelihood ratio and Spearman correlation tests. It was considered significant p < 0,05. RESULTS: Twenty-four patients were included, eight patients in the Anemic group and 16 patients in the Non-anemic group. The groups were similar in terms of clinical, demographic and treatment characteristics, differing only in relation to rheumatoid factor, positive in all anemic participants and in 56,2% of non anemic participants. DAS28 ESR (median 6,05; interquartile range [IQR] 5,21-7,76), DAS28 CRP (median 4,32; IQR 3,98-5,92) and VAS (median 66,50 mm; IQR 54,(75)(76)(77)(78)(79)(80)50) were significantly higher in Anemic group. DAS28 ESR (-0,418) and VAS (-0,426) showed a significant negative correlation with hemoglobin level. DAS28 ESR and DAS28 CRP values were different in the same group, showing a discrepancy in the categorization of disease activity. In Anemic group, DAS28 ESR value (median 6,05; IQR 5,21-7,76) was higher in relation to DAS28 CRP (median 4,32; IQR 3,92). A less discrepant increase of DAS28 ESR (median 4,01; IQR 3,05-5,68) compared to DAS28 CRP (median 3,06; IQR 2,18-4,66) was observed in Non-anemic group. CONCLUSIONS: Anemia was associated with worse disease activity indexes in women with rheumatoid arthritis, being correlated with greater pain intensity and increase of DAS28 ESR score.

show abstract

“…Внедрение в клиническую практику новых эффектив-ных лекарственных средств, так называемых генно-инженерных биологических препара-тов (ГИБП), ингибиторов «сигнальных мо-лекул» и особенно совершенствование стра-тегии лечения РА с использованием стан-дартных базисных противовоспалительных препаратов (БПВП), в первую очередь мето-трексата (МТ), а также глюкокортикоидов (ГК), привело к кардинальному улучшению прогноза при этом заболевании [2,3]. В рам-ках стратегии «Лечение до достижения це-ли» (Treat To Target) задачей терапии РА яв-ляется не только симптоматическое улучше-ние состояния пациента, а достижение со-стояния клинической ремиссии [4,5], кото-рая обусловливает снижение риска потери трудоспособности, инвалидности и увеличе-ние продолжительности жизни пациентов до популяционного уровня [6]. Детальная характеристика и обоснование современных рекомендаций, касающихся лечения РА, представлены в предыдущих публикациях [2,3,7].…”

unclassified

Rheumatoid Arthritis: The Problems of Remission and Therapy Resistance

Nasonov¹,

Олюнин²,

Лила³

2018

rsp

View full text Add to dashboard Cite

Ревматоидный артрит (РА) -иммуновоспалительное (аутоиммунное) ревматическое заболевание неизвест-ной этиологии, характеризующееся хроническим эрозивным артритом и системным поражением внутрен-них органов, приводящее к ранней инвалидности и сокращению продолжительности жизни пациентов. Не-смотря на достигнутые успехи в лечении РА, связанные с разработкой новых лекарственных препаратов и совершенствованием стратегии лечения, позволяющие добиться ремиссии у многих пациентов, остается много теоретических и клинических проблем, касающихся как определения понятия «ремиссия», ее харак-теристики и типов, так и подходов к оптимальной тактике «симптоматической» и «патогенетической» лекар-ственной терапии на разных стадиях болезни, применение которой позволит быстро индуцировать состоя-ние ремиссии и поддерживать ее в долгосрочной перспективе. Необходимы дальнейшие исследования, на-правленные на изучение природы гетерогенности патогенетических механизмов РА и подходов к ранней ди-агностике, совершенствование методов мониторинга активности заболевания, биомаркеров эффективности и резистентности к терапии и, наконец, разработку дифференцированной терапии, в том числе связанной с поиском новых «терапевтических» мишеней. Rheumatoid arthritis (RA) is an immunoinflammatory (autoimmune) rheumatic disease of unknown etiology, which is characterized by chronic erosive arthritis and systemic visceral organ damage that results in early disability and shorter patient survival. Despite RA treatment advances associated with the design of novel drugs and the improvement of treatment strategies to achieve remission in many patients, there are still many theoretical and clinical problems concerning both the definition of the concept of remission, its characteristics and types and approaches to the optimum policy of symptomatic and pathogenetic drug therapy at different stages of the disease, the use of which will be able to rapidly induce and maintain remission in the long-term. Further investigations are needed to study the nature of heterogeneity of pathogenetic mechanisms of RA and approaches to early diagnosis, to improve methods for monitoring disease activity and biomarkers for the efficiency of and resistance to therapy and, finally, to develop differentiation therapy, including those related to a search for new therapeutic targets.

show abstract

Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update

Cited by 293 publications

References 30 publications

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

Anemia e índices de atividade de doença em mulheres com artrite reumatoide

Rheumatoid Arthritis: The Problems of Remission and Therapy Resistance

Contact Info

Product

Resources

About