Long-Term Efficacy of Tumor Necrosis Factor Inhibitors for the Treatment of Methotrexate-Naïve Rheumatoid Arthritis: Systematic Literature Review and Meta-Analysis.

Autor: Gulácsi L; Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary. laszlo.gulacsi@uni-corvinus.hu., Zrubka Z; Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary., Brodszky V; Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary., Rencz F; Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary., Alten R; Rheumatology Research Center, Schlosspark-Klinik Charite, University Medicine Berlin, Berlin, Germany., Szekanecz Z; Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary., Péntek M; Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.; Department of Rheumatology, Flór Ferenc County Hospital, Kistarcsa, Hungary.
Jazyk: angličtina
Zdroj: Advances in therapy [Adv Ther] 2019 Mar; Vol. 36 (3), pp. 721-745. Date of Electronic Publication: 2019 Jan 12.
DOI: 10.1007/s12325-018-0869-8
Abstrakt: Introduction: Synthesis of evidence on the long-term use of first-line biologic therapy in patients with early rheumatoid arthritis (RA) is required. We compared the efficacy of up to 5 years' treatment with first-line tumor necrosis factor inhibitors (TNFis) versus other treatment strategies in this population.
Methods: Previous systematic reviews, PubMed and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) involving treatment of methotrexate-naïve RA patients with first-line TNFis. Literature was synthesized qualitatively, and a meta-analysis conducted to evaluate American College of Rheumatology (ACR) responses, clinical remission defined by any standard measure, and Health Assessment Questionnaire Disability Index (HAQ) at Years 2 and/or 5.
Results: Ten RCTs involving 4306 patients [first-line TNFi, n = 2234; other treatment strategies (control), n = 2072] were included in the meta-analysis. Three studies were double-blind for the first 2 years, while seven were partly/completely open label during this period. Five studies reported data at Year 5; all were open label at this time point. At Year 2, ACR50 response, ACR70 response and remission rates were significantly improved with first-line TNFi versus control in double-blind RCTs [log-odds ratio (OR) 0.32 [95% confidence interval (CI) 0.02, 0.62; p = 0.035], log-OR 0.48 (95% CI 0.20, 0.77; p = 0.001), and log-OR 0.44 (95% CI 0.13, 0.74; p = 0.005), respectively], but not in open-label studies. No significant between-group differences were observed in mean HAQ at Year 2 in double-blind or open-label RCTs or in ACR response or remission outcomes at Year 5.
Conclusion: In double-blind studies, 2-year efficacy outcomes were significantly improved with first-line TNFi versus other treatment strategies in patients with MTX-naïve RA. No significant differences in these outcomes were observed when data from open-label RCTs were considered on their own. Further data on the efficacy of TNFi therapy over ≥ 2 years in patients with methotrexate-naïve RA are required. Plain language summary available for this article.
Databáze: MEDLINE
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