What have we learned from BeSt?

Allaart, Cornelia F; Markusse, I.M.; Lems, Willem F.

doi:10.1016/j.clim.2017.09.017

Cited by 3 publications

(2 citation statements)

References 15 publications

(17 reference statements)

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“…Of the 3879 articles identified through the literature search, 66 articles were selected after title, abstract, full-text and reference screening (figure 1). 27–92 Characteristics of selected articles including RoB assessments are shown in online supplemental table S1. These 66 selected articles concerned results from 40 studies, and from these the data of 169 treatment arms were extracted.…”

Section: Resultsmentioning

confidence: 99%

What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis

et al. 2023

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ObjectivesA treat-to-target (T2T) strategy has been shown to be superior to usual care in rheumatoid arthritis (RA), but the optimal target remains unknown. Targets are based on a disease activity measure (eg, Disease Activity Score-28 (DAS28), Simplified Disease Activity Indices/Clinical Disease Activity Indices (SDAI/CDAI), and a cut-off such as remission or low disease activity (LDA). Our aim was to compare the effect of different targets on clinical and radiographic outcomes.MethodsCochrane, Embase and (pre)MEDLINE databases were searched (1 June 2022) for randomised controlled trials and cohort studies after 2003 that applied T2T in RA patients for ≥12 months. Data were extracted from individual T2T study arms; risk of bias was assessed with the Cochrane Collaboration tool. Using meta-regression, we evaluated the effect of the target used on clinical and radiographic outcomes, correcting for heterogeneity between and within studies.Results115 treatment arms were used in the meta-regression analyses. Aiming for SDAI/CDAI-LDA was statistically superior to targeting DAS-LDA regarding DAS-remission and SDAI/CDAI/Boolean-remission outcomes over 1–3 years. Aiming for SDAI/CDAI-LDA was also significantly superior to DAS-remission regarding both SDAI/CDAI/Boolean-remission (over 1–3 years) and mean SDAI/CDAI (over 1 year). Targeting DAS-remission rather than DAS-LDA only improved the percentage of patients in DAS-remission, and only statistically significantly after 2–3 years of T2T. No differences were observed in Health Assessment Questionnaire and radiographic progression.ConclusionsTargeting SDAI/CDAI-LDA, and to a lesser extent DAS-remission, may be superior to targeting DAS-LDA regarding several clinical outcomes. However, due to the risk of residual confounding and the lack of data on (over)treatment and safety, future studies should aim to directly and comprehensively compare targets.PROSPERO registration numberCRD42021249015.

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Section: Resultsmentioning

confidence: 99%

What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis

et al. 2023

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“…A PRISMA flow diagram for our systematic review is shown in Figure 1 and includes the number of citations found and screened. We identified six RCTs (reported in 26 full text publications) of first-line infliximab in RA: ASPIRE (3 publications) [15,32,33], BeSt (15 publications) [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], Durez 2007 (1 publication) [49], IDEA (1 publication) [12], NEO-RACo (3 publication) [50][51][52] and Quinn 2005 (3 publications) [53][54][55]. The sample size of these RCTs ranged from 20 to 1,049 patients; follow-up times were between 1 and 10 years.…”

Section: Literature Search Of Clinical Studiesmentioning

confidence: 99%

Long-term efficacy and cost-effectiveness of infliximab as first-line treatment in rheumatoid arthritis: systematic review and meta-analysis

Zrubka

Gulàcsi

Brodszky

et al. 2019

Expert Review of Pharmacoeconomics & Outcomes Research

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Introduction: Early biological treatment of rheumatoid arthritis (RA) may reverse the autoimmune response in some patients resulting in favorable long-term outcomes. Although the cost-effectiveness of this strategy has been questioned, biosimilar entries warrant the revision of clinical and pharmaco-economic evidence. Areas covered: We conducted a systematic review of randomized controlled trials (RCTs) published up to 24 May 2018 in Pubmed, EMBASE and Cochrane CENTRAL, comparing infliximab with non-biological therapy in patients with RA naïve to methotrexate. We performed meta-analyses for efficacy outcomes at month 6 and years 1 and 2. Six RCTs were identified, involving 1832 patients. At month 6 ACR70 response and remission, and at year 1 ACR20/ACR70 responses and remission were improved significantly with first-line infliximab versus control. The differences were not significant at year 2. We reviewed cost-utility studies, up to 31 October 2018 in PubMed, Cochrane CENTRAL and the CRD HTA databases. Four studies indicated that first-line use of originator infliximab calculated at 2005-2008 prices was not cost-effective. Expert opinion: We demonstrated the efficacy benefits of first-line infliximab therapy up to 1 year in methotrexate-naïve RA. We highlighted the need for standardized reporting of outcomes and conducting cost-effectiveness analyses of first-line biosimilar therapy in RA.

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Advances in targeted therapies 2017

Breedveld

Kalden

Smolen

2018

Clinical Immunology

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What have we learned from BeSt?

Abstract: Early treatment determines early clinical improvement, treatment-to-target determines long term outcomes. Prevention of relevant radiologic damage progression and disability, drug free remission and normalized survival are realistic goals.

Cited by 3 publications

References 15 publications

What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis

What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis

Long-term efficacy and cost-effectiveness of infliximab as first-line treatment in rheumatoid arthritis: systematic review and meta-analysis

Advances in targeted therapies 2017

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