A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis

Autor: James Galloway, Mark Yates, Benjamin D Clarke, Andrew P. Cope, Mark D Russell, Sam Norton, Andrew I Rutherford, Maryam Adas, Katie Bechman, Victoria B Allen
Rok vydání: 2021
Předmět:
Adult
Male
DMARD naïve
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Combination therapy
Network Meta-Analysis
early rheumatoid arthritis
MEDLINE
Rate ratio
law.invention
Arthritis
Rheumatoid
03 medical and health sciences
0302 clinical medicine
Double-Blind Method
Rheumatology
Randomized controlled trial
law
treatment strategies
Internal medicine
Secondary Prevention
Humans
Medicine
Pharmacology (medical)
030212 general & internal medicine
Adverse effect
AcademicSubjects/MED00360
Randomized Controlled Trials as Topic
030203 arthritis & rheumatology
Biological Products
business.industry
Middle Aged
medicine.disease
adverse events
Methotrexate
Treatment Outcome
Antirheumatic Agents
Rheumatoid arthritis
Meta-analysis
Treatment strategy
Female
Steroids
business
Systematic Review and Meta-Analysis
Zdroj: Rheumatology (Oxford, England)
ISSN: 1462-0332
1462-0324
Popis: Objectives To evaluate the safety of treatment strategies in patients with early RA. Methods Systematic searches of MEDLINE, EMBASE and PubMed were conducted up to September 2020. Double-blind randomized controlled trials (RCTs) of licensed treatments conducted on completely naïve or MTX-naïve RA patients were included. Long-term extension studies, post-hoc and pooled analyses and RCTs with no comparator arm were excluded. Serious adverse events, serious infections and non-serious adverse events were extracted from all RCTs, and event rates in intervention and comparator arms were compared using meta-analysis and network meta-analysis (NMA). Results From an initial search of 3423 studies, 20 were included, involving 9202 patients. From the meta-analysis, the pooled incidence rates per 1000 patient-years for serious adverse events were 69.8 (95% CI: 64.9, 74.8), serious infections 18.9 (95% CI: 16.2, 21.6) and non-serious adverse events 1048.2 (95% CI: 1027.5, 1068.9). NMA showed that serious adverse event rates were higher with biologic monotherapy than with MTX monotherapy, rate ratio 1.39 (95% CI: 1.12, 1.73). Biologic monotherapy rates were higher than those for MTX and steroid therapy, rate ratio 3.22 (95% CI: 1.47, 7.07). Biologic monotherapy had a higher adverse event rate than biologic combination therapy, rate ratio 1.26 (95% CI: 1.02, 1.54). NMA showed no significant difference between strategies with respect to serious infections and non-serious adverse events rates. Conclusion The study revealed the different risk profiles for various early RA treatment strategies. Observed differences were overall small, and in contrast to the findings of established RA studies, steroid-based regimens did not emerge as more harmful.
Databáze: OpenAIRE
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