Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying anti-rheumatic drugs for rheumatoid arthritis: A network meta-analysis

Hazlewood, Glen; Barnabé, Cheryl; Tomlinson, George; Marshall, Deborah A.; Devoe, Daniel J.; Bombardier, Claire

doi:10.1002/14651858.cd010227.pub2

Cited by 83 publications

(81 citation statements)

References 211 publications

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“…We elected to include only trials in which, in 1 arm, bDMARD/tofacitinib was administered with methotrexate, because this combination reflects the most frequent clinical practice and was felt to provide an adequate sample of the majority of RCTs of advanced therapy. This decision also allowed us to leverage a completed systematic review and network meta‐analysis to identify articles (see literature search below) . We purposely included few other restrictions in our eligibility criteria.…”

Section: Methodsmentioning

confidence: 99%

“…Trials were identified from a systematic literature search that had been previously conducted for a network meta‐analysis of methotrexate‐based DMARD treatments . This search was comprehensive up until January 2016 of 9,817 records identified from published databases (Medline, Embase, and Cochrane Central), supplemented with hand searches of Cochrane reviews and meeting abstracts.…”

Section: Methodsmentioning

confidence: 99%

“…We therefore rescreened records from our prior systematic review that had been excluded at either the title/abstract or full‐text stage for any of these reasons; the reasons for exclusion had been previously recorded. Additionally, to identify new trials, we conducted an updated literature search in Medline and Embase to June 20, 2017, using the same search terms from our prior review . The search included medical subject heading terms and keywords for “methotrexate” plus “RA” plus “randomized trial.” Two independent reviewers (MYC, GSH) performed the rescreening of the records, with disagreements resolved through consensus.…”

Section: Methodsmentioning

confidence: 99%

“…Based on these ratings, an overall risk of bias for the trial was assigned as high, unclear, or low. We used our prior risk of bias ratings for trials that were also included in our published systematic review . In this prior review, the risk of bias was assessed separately for different outcome categories (radiographic outcomes, withdrawals, all other clinical outcomes) because the risk of bias may differ for certain domains (e.g., blinding of assessors and incomplete outcome data).…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Pragmaticism of Randomized Controlled Trials of Biologic Treatment With Methotrexate in Rheumatoid Arthritis: A Systematic Review

Choi

Barnabe

Barber

et al. 2019

Arthritis Care & Research

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Pragmaticism of Randomized Controlled Trials of Biologic Treatment With Methotrexate in Rheumatoid Arthritis: A Systematic Review

Choi

Barnabe

Barber

et al. 2019

Arthritis Care & Research

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“…New treatment strategies for RA, including early and effective DMARDs, have resulted in reduced disease activity, but the optimal treatment of lung involvement is still a dilemma [81]. So far, no randomized controlled trials in RA-ILD have been conducted.…”

Section: Treatmentmentioning

confidence: 99%

Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians

Bendstrup

Møller

Kronborg-White

et al. 2019

JCM

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Interstitial lung disease (ILD) is a serious complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Other respiratory complications, such as chronic obstructive pulmonary disease and bronchiectasis, are frequent in RA. Infections and drug toxicity are important differential diagnoses and should be considered in the diagnostic work-up of patients with RA presenting with respiratory symptoms. This review provides an overview of the epidemiology and pathogenesis of RA-ILD, the radiological and histopathological characteristics of the disease as well as the current and future treatment options. Currently, there is no available evidence-based therapy for RA-ILD, and immunosuppressants are the mainstay of therapy. Ongoing studies are exploring the role of antifibrotic therapy in patients with progressive fibrotic ILD, which may lead to a new treatment approach for subgroups of patients with RA-ILD.

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Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

Guski,

Jürgens,

Pedder

et al. 2023

JAMA Netw Open

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ImportanceThis is the first network meta-analysis to assess outcomes associated with multiple conventional synthetic disease-modifying antirheumatic drugs and glucocorticoid.ObjectiveTo analyze clinical outcomes after treatment with conventional synthetic disease-modifying antirheumatic drugs and glucocorticoid among patients with rheumatoid arthritis.Data SourcesWith no time restraint, English language articles were searched in MEDLINE, Embase, Cochrane Central, ClinicalTrials.gov, and reference lists of relevant meta-analyses until September 15, 2022.Study SelectionFour reviewers in pairs of 2 independently included controlled studies randomizing patients with rheumatoid arthritis to mono–conventional synthetic disease-modifying antirheumatic drugs, glucocorticoid, placebo, or nonactive treatment that recorded at least 1 outcome of tender joint count, swollen joint count, erythrocyte sedimentation rate, and C-reactive protein level. Of 1098 assessed articles, 130 articles (132 interventions) were included.Data Extraction and SynthesisThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and data quality was assessed by the Cochrane risk of bias tool RoB 2. Data were extracted by a single author and checked independently by 2 authors. Data were analyzed using a random effect model, and data analysis was conducted from June 2021 to February 2023.Main Outcomes and MeasuresA protocol with hypothesis and study plan was registered before data recording. The most complete of recorded outcomes (tender joint count) was used as primary outcome, with imputations based on other outcomes to obtain a full analysis of all studies. Absolute change adjusted for baseline disease activity was assessed.ResultsA total of 29 interventions in 275 treatment groups among 132 randomized clinical trials (mean [range], 71.0% [27.0% to 100%] females in studies; mean [range] of ages in studies, 53 [36 to 70] years) were identified, which included 13 260 patients with rheumatoid arthritis. The mean (range) duration of RA was 79 (2 to 243) months, and the mean (range) disease activity score was 6.3 (4.0 to 8.8). Compared with placebo, oral methotrexate was associated with a reduced tender joint count by 5.18 joints (95% credible interval [CrI], 4.07 to 6.28 joints). Compared with methotrexate, glucocorticoid (−2.54 joints; 95% CrI, −5.16 to 0.08 joints) and remaining drugs except cyclophosphamide (6.08 joints; 95% CrI, 0.44 to 11.66 joints) were associated with similar or lower tender joint counts.Conclusions and RelevanceThis study’s results support the present role of methotrexate as the primary reference conventional synthetic disease-modifying antirheumatic drug.

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Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying anti-rheumatic drugs for rheumatoid arthritis: A network meta-analysis

Abstract: Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: A network meta-analysis.

Cited by 83 publications

References 211 publications

Pragmaticism of Randomized Controlled Trials of Biologic Treatment With Methotrexate in Rheumatoid Arthritis: A Systematic Review

Pragmaticism of Randomized Controlled Trials of Biologic Treatment With Methotrexate in Rheumatoid Arthritis: A Systematic Review

Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians

Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

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