AI Article Synopsis
- Difficult-to-treat Rheumatoid arthritis (D2T RA) is defined by the lack of response to at least two different biologic drugs, leading to ongoing disease activity, prompting a systematic review of treatment options.
- The study reviewed 42 randomized controlled trials to evaluate the effectiveness and safety of various drugs, finding that tocilizumab, baricitinib, and olokizumab ranked highest in improving disease activity scores.
- The results suggest that tocilizumab, particularly at an 8 mg/4-week dosage, alongside rituximab, are effective and safe options for managing D2T RA, marking tocilizumab as a leading choice for treatment.
Article Abstract
Background: Difficult-to-treat Rheumatoid arthritis (D2T RA) is primarily characterised by failure of at least two different mechanism of action biologic/targeted synthetic disease-modifying antirheumatic drug (DMARDs) with evidence of active/progressive disease. While a variety of drugs have been used in previous studies to treat D2T RA, there has been no systematic summary of these drugs. This study conducted a systematic review of randomized controlled trials aimed at analyzing the efficacy and safety of individual therapeutic agents for the treatment of D2T RA and recommending the optimal therapeutic dose.
Methods: The English databases were searched for studies on the treatment of D2T RA published between the date of the database's establishment and March, 2024. This study uses R 3.1.2 for data analysis, and the rjags package runs JAGS 3.4.0.20. The study fitted a stochastic effects Bayesian network meta-analysis for each outcome measure.
Result: A total of 42 studies were included in this study. Compared with placebo, the improvement of Disease Activity Score of 28 Joints (DAS28) score is ranked from high to low as tocilizumab, baricitinib and opinercept. The improvement of American College of Rheumatology 50 response (ACR50) score in patients with drug use was ranked from good to poor as follows: olokizumab, tocilizumab, adalimumab, baricitinib, and upadacitinib, and 8 mg/4w tocilizumab demonstrated the best efficacy. Notably, rituximab is generally the safest drug. Janus kinase (JAK) inhibitors and T cell costimulation modulators are effective in D2T RA refractory to biologic DMARDs, while JAK inhibitors and interleukin-6 (IL-6) inhibitors show effectiveness in D2T RA refractory to csDMARDs.
Conclusion: Tocilizumab and rituximab have better efficacy and safety in the treatment of D2T RA, and the 8 mg/4w dose of tocilizumab may be the first choice for achieving disease remission.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351028 | PMC |
| http://dx.doi.org/10.1186/s12967-024-05569-x | DOI Listing |
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