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

Abstract

ObjectivesTo perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA).MethodsAn SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials.ResultsFor GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations.ConclusionsAddition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease.

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

“…In addition, observational studies addressing tsDMARDs (Jak inhibitor(s)) have not yet been found. However, RCT data point towards a higher risk of serious infections, infections caused by herpes zoster and tuberculosis, risks that should not be ignored and that warrant further research 2 60. Finally, while glucocorticoids are gaining importance as bridging treatment for RA, no single study meeting the eligibility criteria could be found.…”

“…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.…”

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

“…Согласно данным Британско-го регистра генно-инженерных биологических препара-тов (ГИБП) в ревматологии, в среднем 50% пациентов прекращают лечение первым ГИБП в течение 5 лет пос-ле его назначения из-за недостаточной эффективности или неблагоприятных реакций [1]. 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.…”

Response to: ‘The time has come to revisit alternative interpretations of data underlying the EULAR management recommendations for rheumatoid arthritis’ by Pirilä et al

“…Nevertheless, after a long debate regarding csDMARD combinations, the task force arrived at the decision to recommend primarily the use of methotrexate (MTX) monotherapy plus short-term glucocorticoids (GC). The decision to delete combinations of csDMARDs as a major recommendation was based on the evidence provided by the respective systematic literature reviews (SLR) 3. Indeed, several new data revealed that MTX+GC was as efficacious as csDMARD combinations+GC, but significantly safer 4–6.…”