The Resource Drug therapy for rheumatoid arthritis in adults : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Katrina E. Donahue ... [et al.], (electronic resource)

Drug therapy for rheumatoid arthritis in adults : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Katrina E. Donahue ... [et al.], (electronic resource)

Label
Drug therapy for rheumatoid arthritis in adults : an update
Title
Drug therapy for rheumatoid arthritis in adults
Title remainder
an update
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Katrina E. Donahue ... [et al.]
Contributor
Subject
Genre
Language
  • eng
  • eng
Summary
OBJECTIVES: Compare the benefits and harms of corticosteroids, oral and biologic disease-modifying antirheumatic drugs (DMARDs) for adults with rheumatoid arthritis. DATA SOURCES: English-language articles from 1980 to February 2011 identified through PubMed, Embase, Cochrane Library, and International Pharmaceutical Abstracts; unpublished literature including dossiers from pharmaceutical companies. METHODS: Two people independently selected relevant head-to-head trials of any sample size, prospective cohort studies with at least 100 participants, and relevant good- or fair-quality meta-analyses that compared benefits or harms of 14 drug therapies. Retrospective cohort studies were also included for harms. For biologic DMARDs, placebo-controlled, double-blind RCTs were also included. We required trials and cohort studies to have a study duration of at least 12 weeks. Literature was synthesized qualitatively within and between the two main drug classes (oral and biologic DMARDs). Network meta-analysis also was performed to examine the relative efficacy of biologic DMARDs and comparing withdrawal rates from placebo controlled trials. RESULTS: Head-to-head trials showed no clinically important differences in efficacy among oral DMARD comparisons (methotrexate, sulfasalazine, leflunomide). The only head-to-head trial comparing biologic DMARDs (abatacept vs. infliximab) found no clinically important differences. Combination therapy of biologic DMARDs plus methotrexate improved clinical response rates and functional capacity more than monotherapy with methotrexate. Network meta-analyses found higher odds of reaching ACR 50 response for etanercept compared with most other biologic DMARDs (abatacept, adalimumab, anakinra, infliximab, rituximab, tocilizumab) for methotrexate-resistant patients with active rheumatoid arthritis. Similar overall tolerability profiles were found among oral and biologic DMARDs, but short-term adverse events were more common with biologic DMARDs. Adjusted indirect comparisons of biologic DMARDs found that certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates due to lack of efficacy than adalimumab, anakinra, and infliximab. Certolizumab and infliximab had more, while etanercept had fewer withdrawals due to adverse events than most other drugs. Evidence was insufficient to assess comparative risk of serious adverse events among biologic DMARDs. Combinations of biologic DMARDs have higher rates of serious adverse events than biologic DMARD monotherapy. Limited data existed for subgroups. CONCLUSIONS: Limited head-to-head comparative evidence does not support one therapy over another for adults with rheumatoid arthritis. Network meta-analyses from placebo-controlled trials of biologics suggest some differences, including higher odds of reaching ACR 50 response, but strength of evidence was low
Member of
Cataloging source
DNLM
Funding information
Contract No. 290-2007-10056-I
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WE 346
http://library.link/vocab/relatedWorkOrContributorName
  • Donahue, Katrina E
  • United States
  • Effective Health Care Program
  • Research Triangle Institute-University of North Carolina Evidence-based Practice Center
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • no. 55
  • no. 12-EHC025-EF
http://library.link/vocab/subjectName
  • Arthritis, Rheumatoid
  • Antirheumatic Agents
  • Methotrexate
  • Cohort Studies
  • United States
Label
Drug therapy for rheumatoid arthritis in adults : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Katrina E. Donahue ... [et al.], (electronic resource)
Instantiates
Publication
Note
"April 2012."
Bibliography note
Includes bibliographical references
Dimensions
unknown
Extent
1 online resource (1 PDF file (various pagings))
Form of item
online
Other physical details
ill.
Specific material designation
remote
System control number
  • 1587606
  • (DNLM)BKSHLF:NBK97388
Label
Drug therapy for rheumatoid arthritis in adults : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Katrina E. Donahue ... [et al.], (electronic resource)
Publication
Note
"April 2012."
Bibliography note
Includes bibliographical references
Dimensions
unknown
Extent
1 online resource (1 PDF file (various pagings))
Form of item
online
Other physical details
ill.
Specific material designation
remote
System control number
  • 1587606
  • (DNLM)BKSHLF:NBK97388

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