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

Abstract

ObjectivesTo 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.MethodsMedline, 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.ResultsFifty-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.ConclusionsThe 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.

Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry

“…To date, several bDMARDs acting at different levels of the immune response have been licensed for the treatment of RA. TNFα inhibitors (TNFis) encompass five different agents: infliximab (IFX), including the recently approved infliximab bio-similar (bs-IFX); etanercept (ETA), adalimumab (ADA); golimumab (GOL); and certolizumab pegol (CZP) [1], allowing to choose among different routes and frequency of administration and peculiar pharmacokinetic characteristics. The introduction of the interleukin-6 (IL-6) receptor blocking monoclonal antibody tocilizumab (TCZ), the T-cell co-stimulation inhibitor abatacept (ABA), and the anti-CD20 B-cell depleting agent rituximab (RTX) have further increased the therapeutic armamentarium to treat RA.…”

Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan

“…4,9-11 TNF-α is the most influential inflammatory cytokine in the pathogenesis of RA, and the effectiveness of anti-TNF-α therapy has been demonstrated in RA. 28 Also, in one study of associations between OSA and the autoimmune diseases psoriatric arthritis and ankylosing spondylitis, the presence of OSA in patients receiving TNF-α inhibitors was significantly lower than OSA prevalence in patients not receiving this treatment. 29 Additionally, a relationship is shown between oxidative stress and dental diseases in patients with OSA, particularly periodontitis.…”

Change Over Time in the Pattern of Clinical Response to First-line Biologic Drugs in Patients with Rheumatoid Arthritis: Observational Data in a Real-life Setting

“…The effectiveness of those targeted therapies to achieve remission and low disease activity (LDA) has been demonstrated in randomized controlled trials 4 , progressively increasing the use of bDMARD as a real-life application of the T2T strategy. Nevertheless, in the main international registries, the baseline median disease duration of bDMARD starters has been reported to be significantly high, possibly affecting the overall clinical response to this drug class 5,6 .…”