Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis

Abstract

ObjectivesTo update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) Task Force treatment recommendations.MethodsMEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained.ResultsThe RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or ‘spacing’ was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B).ConclusionsThis systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction.

Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis

“…This SLR is an update of the SLR performed previously for the corresponding 2013 update of the RA management recommendations 6. The results of this and two other SLRs2 3 provided the task force with the current state of evidence.…”

“…However, there are no important differences in efficacy across bDMARDs and tsDMARDs 2 3. Therefore, other aspects among which safety may have a more prominent place in decision-making 1.…”

Efficacy of glucocorticoids, conventional and targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis

“…The results of this and two other systematic literature reviews (SLRs)4 5 provided the task force with the current state of evidence.…”

The Impact of Adequate Psychopharmacotherapy on the Efficiency of Treatment in Patients With Rheumatoid Arthritis

“…Ремиссии через 6 мес от начала терапии стандартными базисными противо-воспалительными препаратами (БПВП), по данным рандомизированных контролируемых исследований (РКИ), достигают лишь 1,6-2,6% больных РА и 7,2-16% пациентов в группах, получающих помимо БПВП то-фацитиниб [2]. По данным РКИ С-EARLY [3], после 10-13 мес приема метотрексата (МТ) ремиссия по кри-териям Европейской антиревматической лиги (EULAR) была достигнута у 15%, а в группе получающих наряду с МТ цертолизумаба пэгол -у 29% больных РА. Извест-но, что 30-40% пациентов с РА, у которых отмечена не-эффективность МТ, не отвечают на ингибиторы фактора некроза опухоли α (ФНОα) [4].…”