Effectiveness and harms of rheumatoid arthritis drugs

This review compared the benefits and safety of different rheumatoid arthritis drugs.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the small joints in the hands and feet causing progressive joint damage and physical disability. The treatment for RA is directed toward the control of joint inflammation and the prevention of joint injury.

Disease-modifying anti-rheumatic drugs (DMARDs) are recommended for patients diagnosed with RA for the purpose of slowing disease progression and long-term disability. There are 2 main types of DMARDs: synthetic (e.g. methotrexate) and biologic (e.g. anti-TNF drugs such as infliximab). Rheumatologists face with the problem of determining which DMARDs should be used, and whether a monotherapy (one drug at a time) or combination of DMARDs should be employed.

This review compared between variety of RA drugs in an effort to evaluate the benefits and harms of each drug group. 

This study reviewed 143 articles published between the years 1980 to 2007, examined and compared data about 3 main drug classes (corticosteroids, synthetic DMARDs, and biological DMARDs) and evaluated combination therapies.

In order to compare between different RA therapy methods researchers focused on the articles' outcomes regarding drug's efficacy (symptoms, quality of life, level of disability and radiographic progression) and harms (specific adverse events, rates of adverse events, and discontinuation attributable to adverse events).

The study found no major or clinically important differences in efficacy among synthetic DMARDs (limited to methotrexate, leflunomide, and sulfasalazine) or among biological DMARDs (adalimumab, etanercept, and infliximab).

Monotherapy with anti–TNF drugs resulted in better radiographic outcomes (less joint damage in imaging) than did methotrexate but with no clinical benefit (i.e., disease activity and well-being). Various combinations of biological DMARDs plus methotrexate had better clinical response rates and functional outcomes than monotherapy with either methotrexate or biologic DMARDs.

Due to limited number of comparative trials, there is not enough evidence to support one monotherapy over the other. Combination therapy (combining few drugs) is clearly more effective for RA patients who failed monotherapy. However, the evidence is insufficient to draw firm conclusions about whether one combination is better than another.

Most studies included in this analysis evaluated drug efficacy in the short term. The study populations where mostly homogenous – not representative of many patients in real clinical practice.