Sélina Hanna, Tiphaine Dujardin, Philippe Gaudin, Athan Baillet, Xavier Romand
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bDMARD Drug Survival In Combination Therapy With Methotrexate In Psoriatic Arthritis: a Systematic Literature Review And Meta-analysis.
Background/purpose: Combination therapy with methotrexate (MTX) has shown to improve biologic Disease Modifying Rheumatic Drugs (bDMARD) survival in rheumatoid arthritis, but interest in MTX combination therapy in Psoriatic Arthritis (PsA) remains controversial. We conducted a systematic literature review and meta-analysis to study whether a combination therapy bDMARD and MTX improves bDMARD drug survival in PsA.
Methods: We performed a systematic literature review to identify all pertinent articles studying ts/bDMARDs drugs survival (TNF inhibitors (TNFi), IL-17, IL-23, IL-12/23 and JAK inhibitors) and MTX in PsA up until December 2023. Hazard ratio's (HR) were extracted. A random-effect model and inverse-variance method were used. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity and to confirm the robustness of the results.
Results: 2,299 records were identified, and twenty studies were included, with a total of 30,634 patients with PsA. All studies were observational. Two studies involved bDMARDs other than TNFi. Combination therapy with MTX was found to be associated with a superior bDMARDs drug survival (HR = 0.82 [CI95%, 0.75, 0.89], p-value < 0.001, I2=45%) and TNFi drug survival (HR=0.79 [CI95%, 0.73, 0.86], p-value < 0.001, I2=27%). A meta-analysis for non-TNFi was not possible due to the limited number of publications.
Conclusion: This meta-analysis shows the positive association between combination therapy bDMARD with MTX and a better bDMARDs drug survival, especially with TNFi. Further studies are needed to confirm this hypothesis with robust evidence such as randomised controlled trials.
期刊介绍：
Bimonthly e-only international journal, Joint Bone Spine publishes in English original research articles and all the latest advances that deal with disorders affecting the joints, bones, and spine and, more generally, the entire field of rheumatology.
All submitted manuscripts to the journal are subjected to rigorous peer review by international experts: under no circumstances does the journal guarantee publication before the editorial board makes its final decision. (Surgical techniques and work focusing specifically on orthopedic surgery are not within the scope of the journal.)Joint Bone Spine is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.
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