RT Journal Article
SR Electronic
T1 Efficacy of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 95
OP 106
DO 10.1136/ard-2022-223365
VO 82
IS 1
A1 Kerschbaumer, Andreas
A1 Sepriano, Alexandre
A1 Bergstra, Sytske Anne
A1 Smolen, Josef S
A1 van der Heijde, Désirée
A1 Caporali, Roberto
A1 Edwards, Christopher John
A1 Verschueren, Patrick
A1 de Souza, Savia
A1 Pope, Janet E
A1 Takeuchi, Tsutomu
A1 Hyrich, Kimme L
A1 Winthrop, Kevin L
A1 Aletaha, Daniel
A1 Stamm, Tanja A
A1 Schoones, Jan W
A1 Landewé, Robert B M
YR 2023
UL http://ard.bmj.com/content/82/1/95.abstract
AB Objectives To update the evidence on efficacy of DMARDs (disease-modifying antirheumatic drugs) and inform the taskforce of the 2022 update of the European Alliance of Associations for Rheumatology (EULAR) recommendations for management of rheumatoid arthritis (RA).Methods This systematic literature review (SLR) investigated the efficacy of conventional synthetic (cs), biological (b), biosimilar and targeted synthetic (ts)DMARDs in patients with RA. Medline, EMBASE, Cochrane CENTRAL and Web of Science were used to identify all relevant articles published since the previous update in 2019 to 14 January 2022.Results Of 8969 search results, 169 articles were selected for detailed review and 47 were finally included. Trials investigated the efficacy of csDMARDs, bDMARDs and tsDMARDs, DMARD switching, tapering and trials investigating different treatment strategies. The compounds investigated were csDMARDs (methotrexate (MTX), leflunomide, sulfasalazine, hydroxychloroquine), bDMARDs (abatacept, adalimumab, certolizumab-pegol, denosumab, etanercept, infliximab, levilimab, olokizumab, opineracept, rituximab, sarilumab, tocilizumab) and tsDMARDs (baricitinib, filgotinib, tofacitinib, upadacitinib). The efficacy of csDMARDs+ short-term glucocorticoids in early RA was confirmed and similar to bDMARD+MTX combination therapy. Interleukin-6 pathway inhibition was effective in trials on olokizumab and levilimab. Janus kinase inhibitor (JAKi) was efficacious in different patient populations. After insufficient response to JAKi, patients could respond to TNFi treatment. Tapering of DMARDs was feasible for a proportion of patients, who were able to taper therapy while remaining in low disease activity or remission.Conclusion The results of this SLR, together with one SLR on safety of DMARD and one on glucocorticoids, informed the taskforce of the 2022 update of the EULAR recommendations for pharmacological management of RA.Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as online supplemental information. Detailed data of all included studies are also available in the public domain.