Roland Staud, MD
How effective are target-oriented drug treatments in rheumatoid arthritis (RA)?
Included studies evaluated drug treatments in adults with RA, had a defined outcome target as the primary endpoint, and specified treatment consequences for failure to reach targets. Targets could be individual, composite, or response measures based on clinical, serologic, patient-reported, functional, or radiographic variables. Outcomes were clinical, functional, serologic, or radiographic changes that were compared between treatment groups.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane databases (all to Dec 2008); American College of Rheumatology and European League Against Rheumatism meeting abstracts (2007 and 2008); and reference lists were searched for English-language studies. 6 randomized controlled trials (RCTs) and 1 non-RCT met the selection criteria. 4 RCTs compared target-oriented treatment with routine care (n = 1259, follow-up range 18 mo to 3 y), 1 compared 2 target-oriented treatments (n = 21, follow-up 40 wk), and 1 included both comparisons but reported data only for the 2 targeted treatments (n = 249, follow-up 2 y). Treatment targets varied, and routine care was based on symptom control in 1 RCT, rheumatologist opinion in 2 RCTs, and rheumatologist opinion and swollen joint count in 1 RCT.
In 4 RCTs, target-oriented treatment improved clinical outcomes more than routine care; results were inconsistent for functional and radiographic outcomes (Table). 2 RCTs (n = 188) assessed 2 target-oriented treatment approaches; groups did not differ for clinical outcomes in 1 (data not reported) and were not compared in the other.
Target-oriented drug treatment improves clinical outcomes more than routine care in rheumatoid arthritis.
Target-oriented drug treatment (TDT) vs routine care in rheumatoid arthritis*
*HAQ = Health Assessment Questionnaire; RCT = randomized controlled trial; other abbreviations defined in Glossary.
Staud R. Review: Target-oriented drug treatment improves clinical outcomes more than routine care in rheumatoid arthritis. Ann Intern Med. ;153:JC3–9. doi: 10.7326/0003-4819-153-6-201009210-02009
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Published: Ann Intern Med. 2010;153(6):JC3-9.
Rheumatoid Arthritis, Rheumatology.
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