Emerging therapies in the treatment of rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease with a significant morbidity defined by marked destruction and deformity of joints. It is characterized by autoantibody production, synovial inflammation, and erosion of the cartilage and bone. The current first‐line treatment for RA is methotrexate (MTX), an orally active disease‐modifying anti‐rheumatic drug (DMARD). Biologic DMARDs that target tumor necrosis factor (TNF) or other molecules have emerged as potent alternative therapies for patients with inadequate response to MTX therapy. Despite the huge success of MTX and/or biologics, there is still a significant unmet medical need in RA. Approximately one‐third of RA patients are nonresponsive to currently available therapies. With their critical roles in mediating multiple inflammatory pathways, small‐molecule tyrosine kinase (TK) inhibitors are gaining attention as candidates for oral RA drugs with positive outcomes for a number of late‐stage clinical trials of small‐molecule Jak (Tasocitinib) or Syk (fostamatinib) inhibitors. With the potential for attenuating multiple inflammatory pathways activated in RA, tasocitinib and fostamatinib may represent new and welcome additions to the RA therapeutic landscape. Drug Dev Res 72:805–816, 2011. © 2011 Wiley Periodicals, Inc.

Effects of magnesium valproate adjuvant therapy on patients with dementia: A systematic review and meta-analysis

“…In addition to, ADAS-cog applied in 6 RCTs [15,22,23,25,28,34] with 538 patients in VPM group was significantly lower than control group (SMD -2.749, 95% CI: -3.684 to -1.813, P < .05) (Fig. 4).…”

“…When VPM was additionally used as an antidementia drug, cognitive effects were measured by Mini-mental State Examination (MMSE) in 16 articles [15,[18][19][20][23][24][25][26][27][28][29][30][33][34][35]38] (included 26 trails) with 1971 patients comparing with monotherapy group, by meta-analysis, the MMSE score (SMD = 0.447, 95% CI: 0.049 to 0.846, P = .028) was significantly improved, but with significant heterogeneity (level of heterogeneity χ 2 = 418.79, df = 25, P < .001, I 2 = 94%) (Fig. 3).…”

“…When VPM was additionally used for psychotropic drugs, the severity of behavioral and psychological symptoms of dementia measured by BRMS in 3 articles [28,32,36] (included 8 trails) with 532 patients (SMD -1.303, 95% CI: -1.709 to -0.898, P < .05) (Fig. 5) significantly improved compared with psychotropic drugs alone.…”

“…When VPM was additionally used, other outcomes including ADL in 7 articles [15,[23][24][25][28][29][30] (included 9 trails) with 850 patients (SMD -1.711, 95% CI: -2.459 to -0.962, P < .05) and PSQI in 3 articles [20,22,28] with 232 patients (SMD -3.751, 95% CI: -4.270 to -3.232, P < .05) both significantly improved, compared with psychotropic drugs or antidementia drugs alone (Fig. 9).…”