Tofacitinib versus Biologic Treatments in Moderate-to-Severe Rheumatoid Arthritis Patients Who Have Had an Inadequate Response to Nonbiologic DMARDs: Systematic Literature Review and Network Meta-Analysis.

IF 2.3 Q2 RHEUMATOLOGY
International Journal of Rheumatology Pub Date : 2017-01-01 Epub Date: 2017-03-09 DOI:10.1155/2017/8417249
Evelien Bergrath, Robert A Gerber, David Gruben, Tatjana Lukic, Charles Makin, Gene Wallenstein
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引用次数: 34

Abstract

Objective. To compare the efficacy and tolerability of tofacitinib, an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), as monotherapy and combined with disease-modifying antirheumatic drugs (DMARDs) versus biological DMARDs (bDMARDs) and other novel DMARDs for second-line moderate-to-severe rheumatoid arthritis (RA) patients by means of a systematic literature review (SLR) and network meta-analysis (NMA). Methods. MEDLINE®, EMBASE®, and Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials (RCTs) published between 1990 and March 2015. Efficacy data based on American College of Rheumatology (ACR) response criteria, improvements in the Health Assessment Questionnaire Disability Index (HAQ-DI) at 6 months, and discontinuation rates due to adverse events were analyzed by means of Bayesian NMAs. Results. 45 RCTs were identified, the majority of which demonstrated a low risk of bias. Tofacitinib 5 mg twice daily (BID) and 10 mg BID monotherapy exhibited comparable efficacy and discontinuation rates due to adverse events versus other monotherapies. Tofacitinib 5 mg BID and 10 mg BID + DMARDs or methotrexate (MTX) were mostly comparable to other combination therapies in terms of efficacy and discontinuation due to adverse events. Conclusion. In most cases, tofacitinib had similar efficacy and discontinuation rates due to adverse events compared to biologic DMARDs.

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托法替尼与生物治疗对非生物DMARDs反应不足的中重度类风湿关节炎患者:系统文献综述和网络荟萃分析
目标。通过系统文献综述(SLR)和网络荟萃分析(NMA),比较tofacitinib(一种口服Janus激酶抑制剂,用于治疗类风湿性关节炎(RA),作为单一疗法并联合改善疾病的抗风湿药物(DMARDs)与生物DMARDs (bDMARDs)和其他新型DMARDs对二线中重度类风湿性关节炎(RA)患者的疗效和耐受性。方法。检索MEDLINE®、EMBASE®和Cochrane中央对照试验注册库,以确定1990年至2015年3月间发表的随机临床试验(rct)。基于美国风湿病学会(ACR)反应标准的疗效数据、6个月时健康评估问卷残疾指数(HAQ-DI)的改善情况以及不良事件导致的停药率采用贝叶斯NMAs分析。结果:共纳入45项随机对照试验,其中大多数显示偏倚风险较低。与其他单药治疗相比,托法替尼5mg每日两次(BID)和10mg BID单药治疗的疗效和因不良事件引起的停药率相当。托法替尼5mg BID和10mg BID + DMARDs或甲氨蝶呤(MTX)在疗效和因不良事件而停药方面与其他联合疗法相当。结论。在大多数情况下,与生物DMARDs相比,托法替尼具有相似的疗效和因不良事件引起的停药率。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
9
审稿时长
24 weeks
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