Intensive therapy and remissions in rheumatoid arthritis: a systematic review.
Hughes, Catherine D
Scott, David L
TITRATE Programme Investigators,
BMC Musculoskelet Disord
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Hughes, C. D., Scott, D. L., Ibrahim, F., & TITRATE Programme Investigators,. (2018). Intensive therapy and remissions in rheumatoid arthritis: a systematic review.. BMC Musculoskelet Disord, 19 (1. 389)https://doi.org/10.1186/s12891-018-2302-5
BACKGROUND: We systematically reviewed the effectiveness of intensive treatment strategies in achieving remission in patients with both early and established Rheumatoid Arthritis (RA). METHODS: A systematic literature review and meta-analysis evaluated trials and comparative studies reporting remission in RA patients treated intensively with disease modifying anti-rheumatic drugs (DMARDs), biologics and Janus Kinase (JAK) inhibitors. Analysis used RevMan 5.3 to report relative risks (RR) in random effects models with 95% confidence intervals (CI). RESULTS: We identified 928 publications: 53 studies were included (48 superiority studies; 6 head-to-head trials). In the superiority studies 3013/11259 patients achieved remission with intensive treatment compared with 1211/8493 of controls. Analysis of the 53 comparisons showed a significant benefit for intensive treatment (RR 2.23; 95% CI 1.90, 2.61). Intensive treatment increased remissions in both early RA (23 comparisons; RR 1.56; 1.38, 1.76) and established RA (29 comparisons RR 4.21, 2.92, 6.07). All intensive strategies (combination DMARDs, biologics, JAK inhibitors) increased remissions. In the 6 head-to-head trials 317/787 patients achieved remission with biologics compared with 229/671 of patients receiving combination DMARD therapies and there was no difference between treatment strategies (RR 1.06; 0.93. 1.21). There were differences in the frequency of remissions between early and established RA. In early RA the frequency of remissions with active treatment was 49% compared with 34% in controls. In established RA the frequency of remissions with active treatment was 19% compared with 6% in controls. CONCLUSIONS: Intensive treatment with combination DMARDs, biologics or JAK inhibitors increases the frequency of remission compared to control non-intensive strategies. The benefits are seen in both early and established RA.
Early or established rheumatoid arthritis, Outcome, Remission, Treatment response
CH is a South Thames Rheumatology Specialist Registrar working in Kings College Hospital. FI is supported by the Academic department of Rheumatology. DLS is supported by TITRATE study programme. The TITRATE study is funded by the National Institute for Health Research (NIHR) as one of its Programme Grants For Applied Research (Grant Reference Number: RP-PG-0610-10066; Programme Title: Treatment Intensities and Targets in Rheumatoid Arthritis Therapy: Integrating Patients’ And Clinicians’ Views – The TITRATE Programme.
National Institute for Health Research (NIHR) (via King's College Hospital NHS Foundation Trust) (unknown)
External DOI: https://doi.org/10.1186/s12891-018-2302-5
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289283
Attribution 4.0 International
Licence URL: http://creativecommons.org/licenses/by/4.0/
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