Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis: A Network...

Area of Science:

• Rheumatology
• Pharmacology
• Clinical Trials

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring effective disease-modifying antirheumatic drugs (DMARDs).
• Conventional synthetic DMARDs (csDMARDs) and glucocorticoids are common treatment options, but comparative effectiveness data is complex.
• This study addresses the need for a comprehensive network meta-analysis comparing these treatments.

Purpose of the Study:

• To conduct the first network meta-analysis evaluating outcomes of various csDMARDs and glucocorticoids in rheumatoid arthritis.
• To compare the clinical efficacy of these treatments based on joint counts and inflammatory markers.
• To establish a hierarchy of treatment effectiveness for RA management.

Main Methods:

• Systematic search of multiple databases (MEDLINE, Embase, Cochrane Central, ClinicalTrials.gov) up to September 2022.
• Inclusion of 132 randomized controlled trials involving 13,260 RA patients comparing csDMARDs, glucocorticoids, or placebo.
• Network meta-analysis using random effect models, assessing tender joint count as the primary outcome.

Main Results:

• Oral methotrexate demonstrated a significant reduction in tender joint count compared to placebo (-5.18 joints).
• Glucocorticoids and most other csDMARDs showed similar or less favorable outcomes for tender joint count compared to methotrexate.
• Data from 29 interventions across 275 treatment groups in 132 trials were analyzed.

Conclusions:

• The findings support methotrexate's established role as the primary reference csDMARD for rheumatoid arthritis.
• Methotrexate offers superior efficacy in reducing joint symptoms compared to placebo.
• This network meta-analysis provides valuable comparative effectiveness data for RA treatment decisions.