Bruce M. Rothschild, MD
In adults with rheumatoid arthritis (RA), what are the relative benefits and harms of various disease-modifying antirheumatic drugs (DMARDs)?
MEDLINE, EMBASE/Excerpta Medica, Cochrane Library, International Pharmaceutical Abstracts, and Center for Drug Evaluation and Research database (to September 2007); reference lists; and drug companies.
Head-to-head, randomized, controlled trials (RCTs) and prospective cohort studies that were published in English, compared DMARDs in ≥ 100 adults with RA, and had ≥ 12 weeks of follow up. If head-to-head studies were not available, meta-analyses that indirectly compared drugs through use of data from placebo-controlled trials were included. 143 articles on 101 studies, including 42 on head-to-head RCTs, met the selection criteria.
Clinical response, radiographic progression, functional capacity, quality of life, and adverse events.
Meta-analysis was not done because of heterogeneity among studies. Efficacy results are summarized in the Table. Short-term adverse event rates were similar for biological and synthetic DMARDs; evidence on rare serious events was insufficient. The combination of 2 biological DMARDs increased adverse events more than a single biological DMARD.
The review found no important clinical differences in efficacy or harm among or between synthetic and biological disease-modifying antirheumatic drugs (DMARDs). A biological DMARD plus methotrexate is more effective than either drug alone.
Relative efficacy of synthetic (syn) and biological (biol) DMARDs in adults with rheumatoid arthritis (RA) at ≥ 12 weeks*
*TNF = tumor-necrosis factor.
†Based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Rothschild BM. Review: Individual DMARDs have similar efficacy for rheumatoid arthritis, but combination therapy improves response. Ann Intern Med. ;148:JC3–5. doi: 10.7326/0003-4819-148-10-200805200-02005
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Published: Ann Intern Med. 2008;148(10):JC3-5.
Rheumatoid Arthritis, Rheumatology.
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