Disease-modifying anti-rheumatic drugs for rheumatoid arthritis: a systematic review and network meta-analysis

Hazlewood, Glen; Whittle, Samuel L; Kamso, Mohammed Mujaab; Akl, Elie A.; Wells, George A.; Tugwell, Peter; Thomas, Megan; Lee, Chloe; Ejaredar, Maede; Choudhary, Daksh; Neuen, Dennis R.; New-Tolley, Julia; Powell, Maria; Quinlivan, Alannah; Qaddoura, Amro; Deardon, Rob; Maxwell, Lara; Pardo, Jordi Pardo; Kelly, Shannon; Buchbinder, Rachelle

doi:10.1002/14651858.cd013562

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…The development of this recommendation was possible through the publication of Australian living recommendations, along with full Evidence to Decision tables and an EtD framework (6). Future recommendations will be supported by ongoing Cochrane living systematic reviews of DMARD therapy (29), also a collaborative effort. In the living guideline model, we will also continue to make use of other guidelines, through the GRADE-adolopment approach.…”

Section: Discussionmentioning

confidence: 99%

Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs

et al. 2022

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Objective To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada. Methods The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for tapering of biologic and targeted synthetic (b/ts) DMARD therapy in patients in sustained remission using the GRADE approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network. Results In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and re-establish their medications if needed. In patients where rapid access to care or re-establishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation. Conclusion This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries and evidence to decision summaries available through the CRA website (www.rheum.ca).

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Section: Discussionmentioning

confidence: 99%

Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs

et al. 2022

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“…Rheumatoid arthritis (RA) is one of the most prevalent conditions globally, with an estimated number of affected individuals ranging from 0.24 to 1%, and women are twice as likely to be affected as men [12]. Although disease-modifying anti-rheumatic drugs (DMARDs) are administered to control in ammation and slow the progression of RA, their use is limited by side effects such as nausea, abdominal pain and increased risk of infections [13]. Whilst MSCs have been previously studied for the treatment of RA and have shown considerable promise owing to their immunomodulatory and antiin ammatory properties [14], the direct mechanism of action of MSCs in RA is currently unknown.…”

Section: Discussionmentioning

confidence: 99%

Mesenchymal stem cell derived proteome can target multiple signalling pathways to ameliorate rheumatoid arthritis: network pharmacology and molecular docking based approach

Tariq,

Farid,

Kohli

2024

Preprint

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Rheumatoid arthritis (RA) is an autoimmune chronic inflammatory disease with a global prevalence of approximately 1%. Mesenchymal stem cells (MSCs) have been thoroughly investigated for the treatment of RA; however, their clinical use is limited due to issues related to cell engraftment. It is now well established that MSCs exert their regenerative effect through the paracrine mechanism of their secreted factors (called the secretome); however, the mechanism by which secretome proteins target diseases is still unclear. This study aimed to investigate the potential of the proteome of the MSC secretome in targeting the key molecular signatures of RA. Secretome from primary human bone marrow MSCs was collected, and proteomic analysis was performed using label-free tandem mass spectrometry. A network pharmacology approach was used to identify the target genes of the MSC proteome as well as therapeutic targets of RA. Proteomic analysis of the MSC secretome confirmed the presence of 187 unique proteins, with 136 direct human gene targets. 52 of the identified genes were common with the 1922 identified targets of RA. Functional annotations of the 52 genes revealed their involvement in multiple RA-related KEGG pathways, such as ECM-receptor interaction, focal adhesion, the PI3K-AKT SIGNALLING pathway, the phagosome, and the p53 pathway. Molecular docking of the top 10 hub proteins with the PI3K-AKT pathway revealed a strong binding affinity forall the hub proteins, indicating the potential mechanism by which the MSC proteome can be used as a therapeutic cocktail to ameliorate RA.

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“…Studies with unpublished results were excluded. (12,13). Following best practices, we consulted with a librarian to develop and refine our search.…”

Section: Methodsmentioning

confidence: 99%

“…We conducted a search in Medline (Ovid 1990 to December 2021), Embase (Ovid 1990 to December 2021), and CENTRAL (inception to December 2021) (see Supplementary Tables 1–3, available on the Arthritis Care & Research website at https://doi.org/10.1002/acr.24978). The search strategy was adapted from the sensitivity‐maximizing Cochrane Highly Sensitive Search Strategy for identifying randomized trials in Medline (2008 revision) and RA filters used previously (12,13). Following best practices, we consulted with a librarian to develop and refine our search.…”

Section: Methodsmentioning

confidence: 99%

Reporting of Determinants of Health Inequities in Rheumatoid Arthritis Randomized Controlled Trials in Canada: A Scoping Review

Thomas

Harrison

Vera

2022

Arthritis Care & Research

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Objective More than ever, it is important to consider inclusion and diversity in rheumatology research. We reviewed and synthesized randomized controlled trials (RCTs) for rheumatoid arthritis (RA) in Canada with the aim of characterizing participants and identifying how determinants of health inequities are reported. Methods We conducted a scoping review following the Arksey and O'Malley framework. We searched Medline (1990 to December 2021), Embase (1990 to December 2021), and CENTRAL (inception to December 2021) for articles meeting inclusion criteria of: 1) used an RCT design; 2) evaluated pharmacologic or nonpharmacologic interventions; 3) included participants with RA; and 4) conducted in Canada. Data extraction was guided by the Campbell and Cochrane Equity Methods Group's PROGRESS‐Plus framework on determinants that lead to health inequities (e.g., place of residence; race; occupation; gender/sex; religion; education; socioeconomic status; and social capital). Results Of 6,290 unique records, 42 were eligible for inclusion. We grouped studies according to 3 time periods: before 2000; 2000–2010; and 2011 to present. Participants of included studies were mostly middle‐aged, female, and White. Sex and age were the most widely reported determinants in 41 studies. Other determinants reported were race (15 studies), education (11 studies), socioeconomic status (7 studies), and occupation (6 studies). Religion, features of relationships, and time‐dependent relationships were not reported in any study. Conclusion This scoping review suggests limited reporting on determinants of health inequities in RCTs for RA in Canada. Establishing reporting standards for equity factors in RCTs is important for addressing health inequities and informing accessible research and care for patients with RA.

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Disease-modifying anti-rheumatic drugs for rheumatoid arthritis: a systematic review and network meta-analysis

Cited by 15 publications

References 29 publications

Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs

Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs

Mesenchymal stem cell derived proteome can target multiple signalling pathways to ameliorate rheumatoid arthritis: network pharmacology and molecular docking based approach

Reporting of Determinants of Health Inequities in Rheumatoid Arthritis Randomized Controlled Trials in Canada: A Scoping Review

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