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Rheumatoid arthritis: previously untreated early disease
Wiranthi M A Gunasekera1, John R Kirwan
1Department of Rheumatology, Peterborough and Stamford NHS Foundation Trust, Peterborough, UK.
BMJ Clinical Evidence
|August 2, 2016
Summary
This systematic overview evaluates first-line treatments for rheumatoid arthritis, comparing various disease-modifying anti-rheumatoid drugs (DMARDs) and glucocorticoids. It identifies interventions likely to be beneficial for managing this chronic autoimmune condition.
Area of Science:
- Rheumatology and Immunology
- Pharmacology and Therapeutics
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease causing symmetrical polyarthritis, primarily affecting hands and feet.
- Current pharmacological treatments for RA include NSAIDs, glucocorticoids (GCs), and various disease-modifying anti-rheumatoid drugs (DMARDs), categorized as synthetic (conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs).
Purpose of the Study:
- To systematically evaluate the comparative effectiveness and safety of different first-line treatment strategies for rheumatoid arthritis.
- To answer specific clinical questions regarding the efficacy of methotrexate monotherapy versus combination therapy, biological DMARDs (bDMARDs) versus csDMARDs, bDMARDs in combination with methotrexate, and glucocorticoids in combination with methotrexate or csDMARDs.
Main Methods:
- A systematic overview of existing evidence was conducted.
- Searches were performed in Medline, Embase, The Cochrane Library, and other databases up to December 2014.
- A GRADE evaluation was applied to 18 PICO (Population, Intervention, Comparison, Outcome) combinations.
Main Results:
- The systematic search identified 2058 studies, with 10 systematic reviews, 22 RCTs, and one follow-up report added at this update.
- Effectiveness and safety data for 22 comparisons involving bDMARDs, csDMARDs, GCs, and methotrexate were analyzed.
- GRADE evaluations were performed to assess the quality of evidence for various treatment comparisons.
Conclusions:
- The study categorized the efficacy of multiple first-line treatment options for rheumatoid arthritis.
- Interventions were identified as likely or unlikely to be beneficial based on effectiveness and safety profiles.
- This overview provides guidance on selecting initial therapies for patients with rheumatoid arthritis who have not previously undergone DMARD treatment.
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