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Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis
  1. Jackie L Nam1,
  2. Sofia Ramiro2,
  3. Cecile Gaujoux-Viala3,
  4. Kaoru Takase1,4,
  5. Mario Leon-Garcia1,5,
  6. Paul Emery1,
  7. Laure Gossec6,
  8. Robert Landewe7,
  9. Josef S Smolen8,9,
  10. Maya H Buch1
  1. 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Academic Medical Center, University of Amsterdam, Amsterdam, and Hospital Garcia de Orta, Almada, Portugal
  3. 3Department of Rheumatology, Nîmes University Hospital, Montpellier I University, Nimes, France
  4. 4Department of Internal Medicine and Clinical Immunology, Graduate School of Medicine and Faculty of Medicine, Yokohama City University, Yokohama, Japan
  5. 5R4 de Reumatologia del Hospital de Valme, Seville, Spain
  6. 6 Rheumatology Department, Paris 06 UPMC University, AP-HP, Pite-Salpetriere Hospital, Paris, France
  7. 7Academic Medical Center, University of Amsterdam, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
  8. 8Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  9. 92nd Department of Medicine, Hietzing Hospital Vienna, Vienna, Austria
  1. Correspondence to Dr Maya H Buch, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK; M.Buch{at}leeds.ac.uk

Abstract

Objectives To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA) to inform the European League Against Rheumatism(EULAR) Task Force treatment recommendations.

Methods Medline, Embase and Cochrane databases were searched for articles published between January 2009 and February 2013 on infliximab, etanercept, adalimumab, certolizumab-pegol, golimumab, anakinra, abatacept, rituximab, tocilizumab and biosimilar DMARDs (bsDMARDs) in phase 3 development. Abstracts from 2011 to 2012 American College of Rheumatology (ACR) and 2011–2013 EULAR conferences were obtained.

Results Fifty-one full papers, and 57 abstracts were identified. The randomised controlled trials (RCT) confirmed the efficacy of bDMARD+conventional synthetic DMARDs (csDMARDs) versus csDMARDs alone (level 1B evidence). There was some additional evidence for the use of bDMARD monotherapy, however bDMARD and MTX combination therapy for all bDMARD classes was more efficacious (1B). Clinical and radiographic responses were high with treat-to-target strategies. Earlier improvement in signs and symptoms were seen with more intensive initial treatment strategies, but outcomes were similar upon addition of bDMARDs in patients with insufficient response to MTX. In general, radiographic progression was lower with bDMARD use, mainly due to initial treatment effects. Although patients may achieve bDMARD- and drug-free remission, maintenance of clinical responses was higher with bDMARD continuation (1B), but bDMARD dose reduction could be applied (1B). There was still no RCT data for bDMARD switching.

Conclusions The systematic literature review confirms efficacy of biological DMARDs in RA. It addresses different treatment strategies with the potential for reduction in therapy, particularly with early disease control, and highlights emerging therapies.

  • Rheumatoid Arthritis
  • DMARDs (biologic)
  • Treatment
  • Anti-TNF
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