Reduction of biologics in rheumatoid arthritis: a systematic review and meta-analysis

Vasconcelos, Leticia Breda e; Silva, Marcus Tolentino; Galvão, Taís Freire

doi:10.1007/s00296-020-04651-z

Cited by 11 publications

(6 citation statements)

References 42 publications

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Section: Resultsmentioning

confidence: 99%

“…DAGDO of TNFis in RA is supported by two systematic reviews8 48 and should therefore be considered in patients in which the treatment target is reached and sustained. DAGDO of abatacept and tocilizumab is also supported by two reviews48 49 but with less evidence compared with TNFis. Dose reduction of rituximab (to 1*500 or 1*200 mg every 6 months) was investigated in a double-blinded RCT and advised by the authors, although formal non-inferiority criteria were not met 50.…”

Section: Resultsmentioning

confidence: 99%

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Points to consider for cost-effective use of biological and targeted synthetic DMARDs in inflammatory rheumatic diseases: results from an umbrella review and international Delphi study

et al. 2023

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ObjectivesTo develop evidence-based points to consider for cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases, specifically rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.MethodsFollowing EULAR procedures, an international task force was formed, consisting of 13 experts in rheumatology, epidemiology and pharmacology from seven European countries. Twelve strategies for cost-effective use of b/tsDMARDs were identified through individual and group discussion. For each strategy, PubMed and Embase were systematically searched for relevant English-language systematic reviews and, for six strategies, additionally for randomised controlled trials (RCTs). Thirty systematic reviews and 21 RCTs were included. Based on the evidence, a set of overarching principles and points to consider was formulated by the task force using a Delphi procedure. Level of evidence (1a–5) and grade (A–D) were determined for each point to consider. Individual voting on the level of agreement (LoA; between 0 (completely disagree) and 10 (completely agree)) was performed anonymously.ResultsThe task force agreed on five overarching principles. For 10 of 12 strategies, the evidence was sufficient to formulate one or more points to consider, leading to 20 in total, regarding response prediction, drug formulary use, biosimilars, loading doses, low-dose initial therapy, concomitant conventional synthetic DMARD use, route of administration, medication adherence, disease activity–guided dose optimisation and non-medical drug switching. Ten points to consider (50%) were supported by level 1 or 2 evidence. The mean LoA (SD) varied between 7.9 (1.2) and 9.8 (0.4).ConclusionThese points to consider can be used in rheumatology practices and complement inflammatory rheumatic disease treatment guidelines to incorporate cost-effectiveness in b/tsDMARD treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Points to consider for cost-effective use of biological and targeted synthetic DMARDs in inflammatory rheumatic diseases: results from an umbrella review and international Delphi study

et al. 2023

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“…Common drugs include tofacitinib. Biological drugs have the advantages of quick onset and good curative effect (32). However, the effects of hepatitis, tuberculosis, and tumor diseases need to be excluded before administration.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis on the efficacy of methotrexate in rheumatoid arthritis

Jiang

Jin

Chen³

et al. 2021

Ann Palliat Med

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Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease dominated by chronic inflammation of the synovium of the joints. Methotrexate (MTX) is the most widely used in the treatment of RA. This study systematically evaluated the clinical efficacy of MTX on RA and provided a theoretical basis for the clinical treatment of RA.Methods: Four English databases (PubMed, Embase, Medline, and Web of Sciences) were searched for randomized controlled trials (RCTs) on MTX treatment of RA published from the date of establishment of the database to 2021. The Cochrane Handbook 5.0.2 was used to perform risk bias evaluation and Review Manager 5.3 was used to conduct a meta-analysis.Results: A total of eight articles were included. The meta-analysis showed that, compared to the control group, the number of patients with DAS28-ESR ≤2.6 [erythrocyte sedimentation rate (ESR)] in the MTX alone or MTX combined treatment groups was higher, and the incidence of adverse events was also higher.However, there was no significant difference in the level of alanine aminotransferase (ALT) after treatment versus the control group.Discussion: MTX alone or MTX combined treatment can better control the condition of RA patients without causing damage to the patient's blood system or liver and kidney function, but may increase the probability of adverse events.

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“…In a recent meta-analysis including patients with IBD treated with anti-TNF-α agents, the pooled incidence of any dermatological reaction was 19% (95% confidence interval (CI) [15][16][17][18][19][20][21][22][23][24], with psoriasis or psoriasiform rash being the most common [8]. The pathophysiology of this paradoxical adverse effect is not completely clear; however, a local increase in interferon alpha (because its release is no longer inhibited by TNF-α) and genetic predisposition may play a role [9].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of de-escalation studies have been performed in patients with RA and axial spondyloarthritis. Multiple systematic reviews and metaanalyses of de-escalation studies demonstrated little or no increase in disease activity compared with standard dosing [16][17][18][19][20]. A Cochrane meta-analysis, including 3315 participants in total, showed that there was no loss of clinical response in about 80% of recent onset RA patients within the first year after dose reduction in etanercept.…”

Section: Introductionmentioning

confidence: 99%

De-Escalation of Anti-Tumor Necrosis Factor Alpha Agents and Reduction in Adverse Effects: A Systematic Review

2022

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Background: The long-term use of anti-TNF-α agents can lead to adverse effects, such as infections and immune-mediated cutaneous reactions. Whether de-escalation by dose reduction or interval lengthening reduces these adverse effects is uncertain. This systematic review aims to compare the incidence of infections and skin manifestations after anti-TNF-α dose de-escalation with standard dosing. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception to January 14, 2022. Randomized controlled trials (RCTs) and observational studies comparing anti-TNF-α de-escalation strategies with standard dosing among patients with inflammatory conditions, that report on infections, skin manifestations, or both, were included. The risk of bias was assessed with the revised Cochrane risk-of bias tool (RCTs) or the Newcastle–Ottawa scale (non-RCTs). Results: Fourteen RCTs and six observational studies (or 2706 patients) were included. Eight RCTs had low risk of bias or some concerns. Four non-RCTs were of good methodological quality. The studies described patients with axial spondyloarthritis (8 studies, 780 patients), rheumatoid arthritis (7 studies, 1458 patients), psoriasis (3 studies, 332 patients), or inflammatory bowel disease (2 studies, 136 patients). De-escalation strategies included interval lengthening (12 studies, 1317 patients), dose reduction (6 studies, 1130 patients), or both (2 studies, 259 patients). Overall, the occurrence of infections and skin manifestations did not differ between standard treatment and de-escalation. The disappearance of infections or skin manifestations after de-escalation was only reported in two studies. The majority of studies focused on etanercept and adalimumab. Heterogeneity in reporting of infections and skin manifestations precluded meta-analysis. Conclusion: We found that anti-TNF-α de-escalation does not reduce infections or skin reactions. A de-escalation strategy should not be recommended for the sole purpose of reducing drug-related adverse effects. The meticulous documentation of adverse effects is recommended to further address this question. Registration: PROSPERO CRD42021252977.

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Reduction of biologics in rheumatoid arthritis: a systematic review and meta-analysis

Cited by 11 publications

References 42 publications

Points to consider for cost-effective use of biological and targeted synthetic DMARDs in inflammatory rheumatic diseases: results from an umbrella review and international Delphi study

Points to consider for cost-effective use of biological and targeted synthetic DMARDs in inflammatory rheumatic diseases: results from an umbrella review and international Delphi study

Systematic review and meta-analysis on the efficacy of methotrexate in rheumatoid arthritis

De-Escalation of Anti-Tumor Necrosis Factor Alpha Agents and Reduction in Adverse Effects: A Systematic Review

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