O20 Efficacy of combination DMARD therapy vs. hydroxychloroquine monotherapy in persistent chikungunya arthritis: a 24-week randomised controlled study

Ravindran, Vinod; Alias, George

doi:10.1016/s0973-3698(11)60109-x

Cited by 2 publications

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“…We examined the full text articles for eight records. Five trials [ 31 – 35 ] with 402 total participants met our inclusion criteria. The other three studies were excluded because they were not randomized trials [ 36 ] or they repeated data that was reported more completely in one of our included trials [ 37 – 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…Included trials were conducted in Réunion [ 31 ] and in India [ 32 – 35 ]. All but one trial used serological tests to diagnose CHIKV; one Indian trial [ 32 ] based diagnoses on clinical and epidemiologic characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…One trial [ 31 ] tested the effectiveness of treatment in the acute phase of CHIKV infection and assessed persisting symptoms. The remaining trials [ 32 – 35 ] tested interventions in patients with musculoskeletal pain and arthritis persisting after the acute and post-acute stages.…”

Section: Resultsmentioning

confidence: 99%

“…Three trials [ 31 – 32 , 35 ] tested the effectiveness of CHQ in reducing symptoms, but each trial’s comparator was different. One trial [ 31 ] used placebo; another trial [ 32 ] used PCM.…”

Section: Resultsmentioning

confidence: 99%

“…tested the effectiveness of DMARDs in combination (MTX, SSZ and HCHQ) for relieving CHIKV-related rheumatic symptoms, compared to the effect of HCHQ monotherapy. Finally, one trial [ 35 ] tested the effectiveness of DMARDs in combination (MTX, SSZ and HCHQ) for relieving CHIKV-related rheumatic symptoms, compared to the effect of HCHQ monotherapy. Table 1 shows summary characteristics of each included trial.…”

Section: Resultsmentioning

confidence: 99%

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Interventions for treating patients with chikungunya virus infection-related rheumatic and musculoskeletal disorders: A systematic review

et al. 2017

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BackgroundChikungunya virus infection (CHIKV) is caused by a mosquito-borne alphavirus. CHIKV causes high fever and painful rheumatic disorders that may persist for years. Because little is known about interventions for treating CHIKV-related illness, we conducted a systematic review.MethodsWe used Cochrane methods. We searched PubMed, EMBASE, Cochrane Library, LILACS and other sources from the earliest records to March 2016. We had no language restrictions. We included randomized controlled trials assessing any intervention for treating acute or chronic CHIKV-related illness. Our primary outcomes were pain relief, global health status (GHS) or health related quality of life (HRQL), and serious adverse events (SAEs). We assessed bias risk with the Cochrane tool and used GRADE to assess evidence quality.ResultsWe screened 2,229 records and found five small trials with a total of 402 participants. Patients receiving chloroquine (CHQ) had better chronic pain relief than those receiving placebo (relative risk [RR] 2.67, 95% confidence interval [CI] 1.23 to 5.77, N = 54), but acute pain relief was marginally not different between groups (mean difference [MD] 1.46, 95% CI 0.00 to 2.92, N = 54). SAEs were similar (RR = 15.00, 95% CI 0.90 to 250.24, N = 54). Comparing CHQ with paracetamol (PCM), CHQ patients had better pain relief (RR = 1.52, 95% CI 1.20 to 1.93, N = 86). Compared with hydroxychloroquine (HCHQ), disease-modifying anti-rheumatic drugs (DMARDs) reduced pain (MD = -14.80, 95% CI -19.12 to -10.48, N = 72). DMARDs patients had less disability (MD = -0.74, 95% CI -0.92 to -0.56, N = 72) and less disease activity (MD = -1.35; 95% CI -1.70 to -1.00; N = 72). SAEs were similar between DMARDs and HCHQ groups (RR = 2.84, 95% CI 0.12 to 67.53, N = 72). Comparing meloxicam (MXM) with CHQ, there was no difference in pain relief (MD = 0.24, 95% CI = -0.81 to 1.29; p = 0.65, N = 70), GHS or HRQL (MD = -0.31, 95% CI -2.06 to 1.44, N = 70) or SAEs (RR = 0.85, 95% CI 0.30 to 2.42, N = 70). Finally, a four-arm trial (N = 120) compared aceclofenac (ACF) monotherapy to ACF+HCHQ, ACF+ prednisolone (PRD), or ACF+HCHQ+PRD. Investigators found reduced pain (p<0.001) and better HRQL (p<0.001) in the two patient groups receiving PRD, compared to those receiving ACF monotherapy or ACF+HCHQ. Trials were at high risk of bias. GRADE evidence quality for all outcomes was very low.ConclusionResults from these small trials provide insufficient evidence to draw conclusions about the efficacy or safety of CHIKV interventions. Physicians should be cautious in prescribing and policy-makers should be cautious in recommending any intervention reviewed here. Rigorous trials with sufficient statistical power are urgently needed, with results stratified by disease stage and symptomology.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions for treating patients with chikungunya virus infection-related rheumatic and musculoskeletal disorders: A systematic review

et al. 2017

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Treatment of chikungunya musculoskeletal disorders: a systematic review

Guaraldo

Wakimoto

Ferreira

et al. 2018

Expert Review of Anti-infective Therapy

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Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists' opinion and experience instead of using higher rated evidence. Areas covered: A systematic review of the literature was performed- not restricted to clinical trials - reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase. Expert commentary: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.

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O20 Efficacy of combination DMARD therapy vs. hydroxychloroquine monotherapy in persistent chikungunya arthritis: a 24-week randomised controlled study

Cited by 2 publications

References 0 publications

Interventions for treating patients with chikungunya virus infection-related rheumatic and musculoskeletal disorders: A systematic review

Interventions for treating patients with chikungunya virus infection-related rheumatic and musculoskeletal disorders: A systematic review

Treatment of chikungunya musculoskeletal disorders: a systematic review

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