REVIEW - Current evidence for the management of RA with biologic DMARDs

[Guest guest]

Ann Rheum Dis. 2010 May 6. [Epub ahead of print]

Current evidence for the management of rheumatoid arthritis with

biological disease-modifying antirheumatic drugs: a systematic

literature review informing the EULAR recommendations for the

management of RA.

Nam JL, Winthrop KL, van Vollenhoven RF, Pavelka K, Valesini G, Hensor

EM, Worthy G, Landewé R, Smolen JS, Emery P, Buch MH.

1Section of Musculoskeletal Disease, Leeds Institute of Molecular

Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.

Abstract

OBJECTIVES: To review the evidence for the efficacy and safety of

biological agents in patients with rheumatoid arthritis (RA) to

provide data to develop treatment recommendations by the European

League Against Rheumatism (EULAR) Task Force.

METHODS: Medline, Embase and Cochrane databases were searched for

relevant articles on infliximab (IFX), etanercept (ETN), adalimumab

(ADA), certolizumab-pegol (CZP), golimumab (GLM), anakinra (ANA),

abatacept (ABT), rituximab (RTX) and tocilizumab (TCZ) published

between 1962 and February 2009; published abstracts from the 2007-2008

American College of Rheumatology (ACR) and EULAR conference were

obtained.

RESULTS: 87 articles and 40 abstracts were identified. In methotrexate

(MTX) naïve patients, biological therapy with IFX, ETN, ADA, GLM or

ABT has been shown to improve clinical outcomes (1B). In MTX/other

synthetic disease-modifying antirheumatic drug (DMARD) failures all

nine biological agents confer benefit (1B), with lower efficacy noted

for ANA. RTX, ABT, TCZ and GLM demonstrate efficacy in tumour necrosis

factor inhibitor (TNFi) failures (1B). Less evidence exists for

switching between IFX, ETN and ADA (3B). Biological and MTX

combination therapy is more efficacious than a biological agent alone

(1B). A safety review shows no increased malignancy risk compared with

conventional DMARDs (3B). TNFi are generally associated with an

increased risk of serious bacterial infection, particularly within the

first 6 months of treatment initiation; increased tuberculosis (TB)

rates with TNFi are highest with the monoclonal antibodies (3B).

CONCLUSIONS: There is good evidence for the efficacy of biological

agents in patients with RA. Safety data confirm an increased risk of

bacterial infection and TB with TNFi compared with conventional

DMARDs.

PMID: 20447957

http://www.ncbi.nlm.nih.gov/pubmed/20447957

Not an MD