当前位置： SCI文献检索 > ANNALS OF INTERNAL MEDICINE期刊下所有文献 > Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis.

Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis.

Abstract：

BACKGROUND:The comparative effectiveness of rheumatoid arthritis therapies is uncertain. PURPOSE:To compare the benefits and harms of disease-modifying antirheumatic drugs (DMARDs) for adults with rheumatoid arthritis. DATA SOURCES:Records limited to the English language and studies of adults were identified by using MEDLINE, EMBASE, The Cochrane Library, and International Pharmaceutical Abstracts from 1980 to September 2007. STUDY SELECTION:Two persons independently selected relevant head-to-head trials and prospective cohort studies with at least 100 participants and 12-week follow-up and relevant good- or fair-quality meta-analyses that compared benefits or harms of 11 drug therapies. For harms, they included retrospective cohort studies. DATA EXTRACTION:Information on study design, interventions, outcomes, and quality were extracted according to a standard protocol. DATA SYNTHESIS:Head-to-head trials (n = 23), mostly examining synthetic DMARDs, showed no clinically important differences in efficacy among synthetic DMARDs (limited to methotrexate, leflunomide, and sulfasalazine) or among anti-tumor necrosis factor drugs (adalimumab, etanercept, and infliximab). Monotherapy with anti-tumor necrosis factor drugs resulted in better radiographic outcomes than did methotrexate but no important differences in clinical outcomes (for example, 20%, 50%, or 70% improvement according to American College of Rheumatology response criteria). Various combinations of biological DMARDs plus methotrexate improved clinical response rates and functional outcomes more than monotherapy with either methotrexate or biological DMARDs. In patients whose monotherapy failed, combination therapy with synthetic DMARDs improved response rates. Numbers and types of short-term adverse events were similar for biological and synthetic DMARDs. The evidence was insufficient to draw conclusions about differences for rare but serious adverse events for biological DMARDs. LIMITATION:Most studies were short-term efficacy trials conducted in selected populations with few comorbid conditions. CONCLUSION:Limited available comparative evidence does not support one monotherapy over another for adults with rheumatoid arthritis. Although combination therapy is more effective for patients whose monotherapy fails, the evidence is insufficient to draw firm conclusions about whether one combination or treatment strategy is better than another or is the best treatment for early rheumatoid arthritis.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Donahue KE,Gartlehner G,Jonas DE,Lux LJ,Thieda P,Jonas BL,Hansen RA,Morgan LC,Lohr KN

doi

10.7326/0003-4819-148-2-200801150-00192

subject

Has Abstract

pub_date

2008-01-15 00:00:00

pages

124-34

issue

eissn

0003-4819

issn

1539-3704

pii

0000605-200801150-00192

journal_volume

148

pub_type

杂志文章,评审

在线工具

Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis.