Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial

Vollenhoven, Ronald F. van; Geborek, Pierre; Forslind, Kristina; Albertsson, Kristina; Ernestam, Sofia; Petersson, Ingemar; Chatzidionysiou, Katerina; Bratt, Johan

doi:10.1016/s0140-6736(12)60027-0

Cited by 200 publications

(148 citation statements)

References 27 publications

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“…In general, our results were in accordance with those of another contemporary meta-analysis (5). Recently, results of a 2-year followup assessment in an open, randomized trial showed that effects of triple DMARD therapy and of infliximab plus MTX were similar (6).…”

Section: To the Editorsupporting

confidence: 92%

The effect of triple therapy versus etanercept plus methotrexate in rheumatoid arthritis: Comment on the article by Moreland et al

Graudal¹,

Jürgens²

2013

Arthritis & Rheumatism

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Section: To the Editorsupporting

confidence: 92%

The effect of triple therapy versus etanercept plus methotrexate in rheumatoid arthritis: Comment on the article by Moreland et al

Graudal¹,

Jürgens²

2013

Arthritis & Rheumatism

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“…This bias involved 2 studies, which were performed in Asia and Latin America, in patients with long disease duration, an inadequate response to previous DMARDs, and no treatment with a course of GC (11,12,16). In contrast, the other studies (3,4,9,10,13,15) were performed in North America and Europe, and generally in DMARD-naive early arthritis patients.…”

Section: Discussionmentioning

confidence: 99%

Combination Therapy With and Without Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: A Meta‐Analysis of Randomized Trials

Graudal

Hubeck-Graudal

Faurschou

et al. 2015

Arthritis Care & Research

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Objective. The costs of biologic treatment per patient with rheumatoid arthritis (RA) are approximately 100 times the costs of treatment with a combination of conventional disease-modifying antirheumatic drugs (DMARDs). Despite this, biologic agents have not been proven superior. We compared the effects of combination DMARD therapies with and without biologic agents as therapy for patients with RA. Methods. Eight randomized controlled trials published in 10 articles were selected from a systematic literature search of 1,674 identified studies and integrated in a meta-analysis. These trials compared combinations of DMARDs versus a tumor necrosis factor (TNF) inhibitor plus methotrexate. Two reviewers independently entered data into standardized extraction forms. The combined effect measures were compared by means of the inverse variance method (continuous data) and the Mantel-Haenszel method (dichotomous data) using a random-effects model. Results. The primary outcome, radiographic progression score, did not differ between the combination DMARD group and the TNF inhibitor group, neither during the second year (20.09 units [20.61, 0.44]) of treatment or during the first 2 years (0.66 units [20.12, 1.43]). There were significant differences in the radiographic progression score, the American College of Rheumatology criteria for 50% improvement (ACR50), and the ACR70 response criteria at 6 months in favor of TNF inhibitor treatment, but these differences were not present in patients treated with an initial steroid course and disappeared at 24 months, irrespective of the use of steroids. Conclusion. The difference between DMARD combination treatments, including or excluding TNF inhibitors, is small. Due to the enormous cost differences, RA guidelines should recommend combination DMARD treatment before initiation of TNF inhibitors.

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“…The only combination with a better risk/benefit profile than MTX alone was MTX + Hydroxychloroquine + Sulfasalazine (44). Two recent studies have compared the efficacy and safety of this triple combination therapy to that of anti-TNF, revealing that the addition of a biological drug (not only anti-TNF) improves both clinical and radiological outcomes (45)(46)(47)(48). The recommendation was approved by 76.5% of participants.…”

Section: Recommendation 9: Methotrexate As the First Choice In Rheumamentioning

confidence: 99%

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

et al. 2013

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summaryThe objective of this review is to update the recommendations of the 2010 Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) and other rheumatic diseases. The literature published between 2008 and 2012 was systematically reviewed and updated recommendations on MTX use in rheumatic diseases, particularly RA, were formulated. These recommendations were approved by a panel of expert Italian Rheumatologists. A total of 10,238 references were identified, among which 70 studies were selected for critical evaluation. Sufficient evidence had accumulated to warrant changes to several of the recommendations in the new version. A new recommendation for patients with RA who are in MTX-induced clinical remission was also proposed and approved by the panel. Updated recommendations for the use of MTX in patients with RA or other rheumatologic disease are proposed.

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Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial

Cited by 200 publications

References 27 publications

The effect of triple therapy versus etanercept plus methotrexate in rheumatoid arthritis: Comment on the article by Moreland et al

The effect of triple therapy versus etanercept plus methotrexate in rheumatoid arthritis: Comment on the article by Moreland et al

Combination Therapy With and Without Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis: A Meta‐Analysis of Randomized Trials

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

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