In a nutshell
This study reviewed the effectiveness of drugs used to treat rheumatoid arthritis (RA).
Some background
Rheumatoid arthritis (RA) is a chronic disease. It is caused by painful inflammation in the joints. Over time this can lead to degeneration of joint tissue and disability. RA is managed with disease-modifying anti-rheumatic drugs (DMARDs). There are many types of DMARDs. Conventional (csDMARDs) and biological DMARDs (bDMARDs) are the most commonly used DMARDs. Targeted DMARDs (tsDMARDs) are a newer class of DMARDs. There are also generic versions of bDMARDs. These are called biosimilar DMARDs (bsDMARDs).
The European League against Rheumatism (EULAR) review treatments and produce a guideline. An updated guideline was produced in 2019 after a review of the effectiveness of DMARDs.
Methods & findings
This study reviewed 136 articles on the effectiveness of medications for RA.
5 studies compared csDMARDs. Similar levels of effectiveness were observed. 21 studies compared bDMARDs alone or in combination with csDMARDs. bDMARDs showed similar levels of effectiveness in these studies. 24 studies compared bDMARDs to bsDMARDs. bsDMARDs were just as effective as bDMARDs in these studies. Switching from a bDMARD to a bsDMARD was safe and RA symptoms were still managed.
7 studies directly compared bDMARDs. Rituximab (Rituxan) was just as effective as tumor necrosis factor inhibitor (TNFi) drugs. Sarilumab (Kevzara) was more effective than adalimumab (Humira). The effectiveness of mavrilimumab was similar to golimumab (Simponi) in one study. Certolizumab pegol (Cimzia) was similarly effective as adalimumab.
3 studies compared switching between different DMARDs. There was some evidence that this is effective. 5 studies investigated bDMARDs in early RA. Tocilizumab (Actemra) and infliximab (Remicade) showed some improvement with these patients compared to methotrexate (MTX).
32 studies reported on tsDMARDs. JAK inhibitors (JAKi) were the most common tsDMARD. JAKi drugs were effective alone or in combination with csDMARDs such as MTX. 3 trials compared JAKi to adalimumab. Overall JAKis were not superior to adalimumab or other TNFi. 25 studies investigated reducing or stopping DMARDs (tapering). Tapering was safe in patients with remission (no RA symptoms).
The bottom line
This study reviewed the effectiveness of drugs used to treat RA.
What’s next?
If you have any concerns regarding RA treatment please consult with your doctor.
Published By :
Annals of the rheumatic diseases
Date :
Feb 07, 2020
