Efficacy of Monotherapy with Biologics and JAK Inhibitors for the Treatment of Rheumatoid Arthritis: A Systematic Review View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-08-20

AUTHORS

Paul Emery, Janet E. Pope, Klaus Kruger, Ralph Lippe, Ryan DeMasi, Sadiq Lula, Blerina Kola

ABSTRACT

Despite recommendations suggesting that biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) should be used in combination with methotrexate in the treatment of rheumatoid arthritis (RA), up to one-third of patients with RA are treated with monotherapy. The objective of the systematic literature review reported here was to evaluate the clinical evidence regarding the efficacy of b/tsDMARDs as monotherapy in the treatment of RA. MEDLINE®, Embase®, and the Cochrane Central Trials Register (to April 11, 2017) and the American College of Rheumatology and European League Against Rheumatism conference proceedings (2010-2016) were searched for randomized controlled trials evaluating the efficacy of b/tsDMARDs as monotherapy for RA in adults. Forty-four monotherapy studies of abatacept, adalimumab, baricitinib, certolizumab pegol, etanercept, sarilumab, sirukumab, tocilizumab, and tofacitinib reported in 71 publications were identified. Tocilizumab had the most studies (14), followed by etanercept (10) and adalimumab (9). These b/tsDMARDs were consistently shown to be efficacious treatments, regardless of whether patients were intolerant of or had never used conventional synthetic (cs) DMARDs. However, better treatment outcomes were usually achieved with combination therapy, and this was observed for all b/tsDMARDs assessed by this review. Only a few studies provided a head-to-head comparison between b/tsDMARD treatments or between b/tsDMARD monotherapy and combination therapy, and as many were initial RA treatments they were not generalizable to usual care. In conclusion, evidence from randomized trials suggests that the b/tsDMARDs studied are effective as monotherapy. In general, some patient responses seem better with combination therapy and the durability of monotherapy is less than combination therapy. There is, however, a need for longer-term head-to-head trials to establish positioning of these interventions in the treatment algorithm for RA. FUNDING: Pfizer.Plain Language Summary: Plain language summary available on the journal website. More... »

PAGES

1535-1563

References to SciGraph publications

  • 2015-08-25. Use of Anti-Tumor Necrosis Factor Therapy: A Retrospective Study of Monotherapy and Adherence to Combination Therapy with Non-Biologic Disease-Modifying Anti-Rheumatic Drugs in RHEUMATOLOGY AND THERAPY
  • 2009-12-19. Effects of the anti-interleukin-6 receptor antibody, tocilizumab, on serum lipid levels in patients with rheumatoid arthritis in RHEUMATOLOGY INTERNATIONAL
  • 2008-08-15. A comparison study of a recombinant tumor necrosis factor receptor:Fc fusion protein (rhTNFR:Fc) and methotrexate in treatment of patients with active rheumatoid arthritis in China in RHEUMATOLOGY INTERNATIONAL
  • 2010-06-24. Etanercept (ETN) with methotrexate (MTX) is better than ETN monotherapy in patients with active rheumatoid arthritis despite MTX therapy: a randomized trial in MODERN RHEUMATOLOGY
  • 2012-09-26. A phase 3 randomized, double-blind, multicenter comparative study evaluating the effect of etanercept versus methotrexate on radiographic outcomes, disease activity, and safety in Japanese subjects with active rheumatoid arthritis in MODERN RHEUMATOLOGY
  • 2015-11-04. Effects of tofacitinib monotherapy on patient-reported outcomes in a randomized phase 3 study of patients with active rheumatoid arthritis and inadequate responses to DMARDs in ARTHRITIS RESEARCH & THERAPY
  • 2014-07-03. Comparative efficacy of biologics as monotherapy and in combination with methotrexate on patient reported outcomes (PROs) in rheumatoid arthritis patients with an inadequate response to conventional DMARDs – a systematic review and network meta-analysis in HEALTH AND QUALITY OF LIFE OUTCOMES
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    http://scigraph.springernature.com/pub.10.1007/s12325-018-0757-2

    DOI

    http://dx.doi.org/10.1007/s12325-018-0757-2

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1106255649

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30128641


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