PMID- 30697252
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 1734-1922 (Print)
IS  - 1896-9151 (Electronic)
IS  - 1734-1922 (Linking)
VI  - 15
IP  - 1
DP  - 2019 Jan
TI  - Efficacy and safety of various anti-rheumatic treatments for patients with 
      rheumatoid arthritis: a network meta-analysis.
PG  - 33-54
LID - 10.5114/aoms.2018.73714 [doi]
AB  - INTRODUCTION: Biologics and traditional disease-modifying anti-rheumatic drugs 
      (DMARDs) are generally used in treating patients with rheumatoid arthritis (RA). 
      Previous studies have presented abundant data and information about the efficacy 
      of such treatments, but the results were incomplete and inconclusive. This 
      network meta-analysis was conducted to compare and assess the efficacy and safety 
      of 15 therapies employing biologics and DMARDs for RA patients. MATERIAL AND 
      METHODS: Six outcomes (American College of Rheumatology 20% response rate 
      (ACR20), ACR50, ACR70, remission, adverse events (AEs) and serious adverse events 
      (SAEs)) were used to evaluate the efficacy and safety of different treatments. 
      The node-splitting method was used to assess the inconsistency, and the rank 
      probabilities of the therapies were estimated by surface under the cumulative 
      ranking curve. Besides, Jadad scale was used to evaluate the methodological 
      quality of eligible studies. RESULTS: A total of 67 randomized controlled trials 
      with 20,898 patients met the inclusion criteria. Most of the therapies presented 
      better performance than conventional DMARDs (cDMARDs) and placebo in ACR20, ACR50 
      and ACR70. Conversely, the safety of cDMARDs and placebo seemed to be superior in 
      AEs and SAEs. Also, tocilizumab (TCZ) and TCZ + methotrexate (MTX) showed better 
      remission in pain compared to other treatments. Overall, certolizumab pegol (CZP) 
      + MTX and TCZ + MTX had higher probability than the other treatments in efficacy 
      outcomes. CONCLUSIONS: We recommend CZP + MTX as the optimal drug therapy because 
      it has the highest ranking in efficacy outcomes and relatively low risk of 
      adverse events. TCZ + MTX is recommended as an alternative. Abatacept (ABT) and 
      cDMARDs are not recommended due to their low efficacy.
FAU - Ma, Kexun
AU  - Ma K
AD  - The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, 
      Jiangsu, China.
FAU - Li, Ling
AU  - Li L
AD  - Department of Rheumatology, Taizhou Hospital of TCM, Taizhou, Jiangsu, China.
FAU - Liu, Chunhui
AU  - Liu C
AD  - The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, 
      Jiangsu, China.
FAU - Zhou, Lingling
AU  - Zhou L
AD  - College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 
      China.
FAU - Zhou, Xueping
AU  - Zhou X
AD  - The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, 
      Jiangsu, China.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20181230
PL  - Poland
TA  - Arch Med Sci
JT  - Archives of medical science : AMS
JID - 101258257
PMC - PMC6348345
OTO - NOTNLM
OT  - biologics
OT  - disease-modifying anti-rheumatic drugs
OT  - network meta-analysis
OT  - rheumatoid arthritis
COIS- The authors declare no conflict of interest.
EDAT- 2019/01/31 06:00
MHDA- 2019/01/31 06:01
PMCR- 2019/01/01
CRDT- 2019/01/31 06:00
PHST- 2016/12/23 00:00 [received]
PHST- 2017/03/22 00:00 [accepted]
PHST- 2019/01/31 06:00 [entrez]
PHST- 2019/01/31 06:00 [pubmed]
PHST- 2019/01/31 06:01 [medline]
PHST- 2019/01/01 00:00 [pmc-release]
AID - 31923 [pii]
AID - 10.5114/aoms.2018.73714 [doi]
PST - ppublish
SO  - Arch Med Sci. 2019 Jan;15(1):33-54. doi: 10.5114/aoms.2018.73714. Epub 2018 Dec 
      30.