In a nutshell
This study investigated if tumor necrosis factor inhibitors (TNFi) are effective as a first-line treatment of rheumatoid arthritis (RA). They found that patients treated first with TNFi had greater improvements in RA symptoms.
Rheumatoid arthritis (RA) is a chronic disease. It is caused by inflammation that leads to painful swelling in the joints. There are a number of drugs used to treat RA. One of the types of drugs used to treat RA is called biologics (BG). BG work in a different way to conventional drugs. They suppress the immune system in very specific ways.
Conventional drugs do not manage RA symptoms in all patients. BGs are a good option for these patients. Tumor necrosis factor inhibitors (TNFi) are one type of BGs. TNFis block a protein which is important in sustaining inflammation. Recently, studies have shown that giving a patients TNFi as a first-line (FL) treatment improves RA symptoms. These studies have been short-term. It is unclear if starting a patient on TNFi will improve long-term RA symptoms.
Methods & findings
This study performed an analysis of 10 clinical trials. These trials included 4306 patients with early RA. Patients in these studies were taking either TNFi or conventional first-line RA treatment. In some studies, patients and doctors were blinded to which treatment was given (double-blind). In other studies, patients and doctors knew what treatment was being administered (unblinded). This study looked at the long-term RA symptoms. Disease activity (DA) was measured using standard questionnaires (such as the ACR50 and ACR70).
After 2 years, DA scores were better in TNFi patients. This result was observed in patients in the blinded trials only. DA was reduced by 68% and 52% according to the ACR50 and ACR70 scores. Remission rates (no symptoms) were improved in TNFi patients. At 5 years, all of the studies were unblinded. There was no significant difference in disease activity scores after 5 years.
The bottom line
The authors concluded that patients treated first with TNFis had greater improvements in RA symptoms on the long-term (at least up to 2 years).
The fine print
The non-blinded studies included in the analysis did not support the effectiveness of TNFis in early RA. More long-term, blinded studies are needed to confirm these findings.
If you have any concerns regarding RA treatment, please consult with your physician.
Published By :
Advances in therapy
Jan 12, 2019
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