TY - JOUR
T1 - Efficacy of biological disease-modifying antirheumatic drugs
T2 - A systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis
AU - Nam, Jackie L.
AU - Takase-Minegishi, Kaoru
AU - Ramiro, Sofia
AU - Chatzidionysiou, Katerina
AU - Smolen, Josef S.
AU - Van Der Heijde, Désirée
AU - Bijlsma, Johannes W.
AU - Burmester, Gerd R.
AU - Dougados, Maxime
AU - Scholte-Voshaar, Marieke
AU - Van Vollenhoven, Ronald
AU - Landewé, Robert
PY - 2017
Y1 - 2017
N2 - Objectives: To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) Task Force treatment recommendations. Methods: MEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained. Results: The RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or 'spacing' was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B). Conclusions: This systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction.
AB - Objectives: To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) Task Force treatment recommendations. Methods: MEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained. Results: The RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or 'spacing' was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B). Conclusions: This systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction.
UR - http://www.scopus.com/inward/record.url?scp=85019208873&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/annrheumdis-2016-210713
DO - https://doi.org/10.1136/annrheumdis-2016-210713
M3 - Article
C2 - 28283512
SN - 0003-4967
VL - 76
SP - 1108
EP - 1113
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 6
ER -