Comparison of Treatment Strategies in Early Rheumatoid Arthritis

Goekoop-Ruiterman, Yvonne P M; Vries-Bouwstra, Jeska K de; Allaart, Cornelia F; Zeben, Derkjen van; Kerstens, P.; Hazes, J. M. W.; Zwinderman, A. H.; Peeters, A.J.; Jonge-Bok, J. M. De; Mallee, C.; Beus, W M de; Sonnaville, Peter B J de; Ewals, J. A. P. M.; Breedveld, Ferdinand C.; Dijkmans, Ben A. C.

doi:10.7326/0003-4819-146-6-200703200-00005

Cited by 407 publications

(267 citation statements)

References 24 publications

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“…The results from the BeSt and SWEFOT (Swedish Farmacotherapy) trials indicate that step-up therapy using sulfasalazine (SSZ) and hydroxychloroquine (HCQ) in these patients is inferior to the addition of a TNF inhibitor. 60,74,75 In contrast, the results of the TEAR trial suggest that step-up treatment using SSZ and HCQ is comparably effective to step-up etanercept therapy in both clinical response and radiographic outcomes. 65,66 To mitigate this apparent contradiction, we have considered data regarding the probability of remission at 1 year on the basis of absolute disease activity at 3 months.…”

Section: Critical Time Pointmentioning

confidence: 97%

“…57 This conclusion is supported by a 2010 Cochrane systematic review that emphasized lack of evidence of a statistically significant advantage for initial combination therapy using MTX and other conventional DMARDs over monotherapy with MTX. 58 A [59][60][61][62][63][64] The results of these studies suggest that the combination of MTX with a TNF inhibitor or CTLA-4:Ig (abatacept) has greater efficacy than MTX monotherapy insofar as both clinical and radiographic outcomes are concerned.…”

Section: Treatment Approach Initial Treatment Approachmentioning

confidence: 99%

“…36, 60 The absolute disease activity state, either low disease activity or remission, as defined by the SDAI, has been found in a meta-analysis of biologic therapy to be strongly predictive of the probability of remission at 1 year irrespective of initial MTX monotherapy or combination therapy with TNF inhibitors. 72 Not many more patients achieve remission at 6 months than at 3 months.…”

Section: Critical Time Pointmentioning

confidence: 99%

“…36,60,72,74 In this setting, both TNF inhibitors 59,62,[76][77][78] and abatacept 79 are approved and are recommended biologic response modifiers for step-up treatment. Although interleukin 1 receptor antagonist therapy (anakinra) is approved for treatment in this context, we regard this medication as generally less effective than the above-mentioned agents, and, thus, cannot recommend its use at this disease stage.…”

Section: Critical Time Pointmentioning

confidence: 99%

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My Treatment Approach to Rheumatoid Arthritis

Davis

Matteson

2012

Mayo Clinic Proceedings

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The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival.

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Section: Critical Time Pointmentioning

confidence: 97%

Section: Treatment Approach Initial Treatment Approachmentioning

confidence: 99%

Section: Critical Time Pointmentioning

confidence: 99%

Section: Critical Time Pointmentioning

confidence: 99%

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My Treatment Approach to Rheumatoid Arthritis

Davis

Matteson

2012

Mayo Clinic Proceedings

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“…A recent indirect comparison network meta-analysis indicated that the effects of combination treatments with and without biologic agents might have similar properties to reduce radiographic joint destruction (2). Until recently, only 1 randomized controlled trial (RCT) directly supported this hypothesis (3,4). The 4 most sold drugs in the world with regard to sales (but not defined daily doses) are biologic agents primarily indicated for RA (adalimumab, infliximab, rituximab, and etanercept).…”

Section: Introductionmentioning

confidence: 99%

Combination Therapy With and Without Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: A Meta‐Analysis of Randomized Trials

Graudal

Hubeck-Graudal

Faurschou

et al. 2015

Arthritis Care & Research

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Objective. The costs of biologic treatment per patient with rheumatoid arthritis (RA) are approximately 100 times the costs of treatment with a combination of conventional disease-modifying antirheumatic drugs (DMARDs). Despite this, biologic agents have not been proven superior. We compared the effects of combination DMARD therapies with and without biologic agents as therapy for patients with RA. Methods. Eight randomized controlled trials published in 10 articles were selected from a systematic literature search of 1,674 identified studies and integrated in a meta-analysis. These trials compared combinations of DMARDs versus a tumor necrosis factor (TNF) inhibitor plus methotrexate. Two reviewers independently entered data into standardized extraction forms. The combined effect measures were compared by means of the inverse variance method (continuous data) and the Mantel-Haenszel method (dichotomous data) using a random-effects model. Results. The primary outcome, radiographic progression score, did not differ between the combination DMARD group and the TNF inhibitor group, neither during the second year (20.09 units [20.61, 0.44]) of treatment or during the first 2 years (0.66 units [20.12, 1.43]). There were significant differences in the radiographic progression score, the American College of Rheumatology criteria for 50% improvement (ACR50), and the ACR70 response criteria at 6 months in favor of TNF inhibitor treatment, but these differences were not present in patients treated with an initial steroid course and disappeared at 24 months, irrespective of the use of steroids. Conclusion. The difference between DMARD combination treatments, including or excluding TNF inhibitors, is small. Due to the enormous cost differences, RA guidelines should recommend combination DMARD treatment before initiation of TNF inhibitors.

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