Cargando…

Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis

Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient’s response to the treatment and th...

Descripción completa

Detalles Bibliográficos
Autores principales: de Castro, Caroline Tianeze, de Queiroz, Mariana Jorge, Albuquerque, Flavia Caixeta, Brandão, Celmário Castro, Gerlack, Leticia Farias, Pereira, Daniella Cristina Rodrigues, Barros, Sandra Castro, Andrade, Wenderson Walla, Bastos, Ediane de Assis, Azevedo, Jessé de Nobrega Batista, Carreiro, Roberto, Barreto, Mauricio Lima, dos Santos, Djanilson Barbosa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9402894/
https://www.ncbi.nlm.nih.gov/pubmed/36034836
http://dx.doi.org/10.3389/fphar.2022.927179
_version_ 1784773245286744064
author de Castro, Caroline Tianeze
de Queiroz, Mariana Jorge
Albuquerque, Flavia Caixeta
Brandão, Celmário Castro
Gerlack, Leticia Farias
Pereira, Daniella Cristina Rodrigues
Barros, Sandra Castro
Andrade, Wenderson Walla
Bastos, Ediane de Assis
Azevedo, Jessé de Nobrega Batista
Carreiro, Roberto
Barreto, Mauricio Lima
dos Santos, Djanilson Barbosa
author_facet de Castro, Caroline Tianeze
de Queiroz, Mariana Jorge
Albuquerque, Flavia Caixeta
Brandão, Celmário Castro
Gerlack, Leticia Farias
Pereira, Daniella Cristina Rodrigues
Barros, Sandra Castro
Andrade, Wenderson Walla
Bastos, Ediane de Assis
Azevedo, Jessé de Nobrega Batista
Carreiro, Roberto
Barreto, Mauricio Lima
dos Santos, Djanilson Barbosa
author_sort de Castro, Caroline Tianeze
collection PubMed
description Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient’s response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81–0.95; p < 0.01; I(2) = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79–0.94; p < 0.01; I(2) = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05–1.36; p < 0.01; I(2) = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68–1.00; p < 0.01; I(2) = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.
format Online
Article
Text
id pubmed-9402894
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-94028942022-08-26 Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis de Castro, Caroline Tianeze de Queiroz, Mariana Jorge Albuquerque, Flavia Caixeta Brandão, Celmário Castro Gerlack, Leticia Farias Pereira, Daniella Cristina Rodrigues Barros, Sandra Castro Andrade, Wenderson Walla Bastos, Ediane de Assis Azevedo, Jessé de Nobrega Batista Carreiro, Roberto Barreto, Mauricio Lima dos Santos, Djanilson Barbosa Front Pharmacol Pharmacology Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient’s response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81–0.95; p < 0.01; I(2) = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79–0.94; p < 0.01; I(2) = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05–1.36; p < 0.01; I(2) = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68–1.00; p < 0.01; I(2) = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838. Frontiers Media S.A. 2022-08-11 /pmc/articles/PMC9402894/ /pubmed/36034836 http://dx.doi.org/10.3389/fphar.2022.927179 Text en Copyright © 2022 Castro, Queiroz, Albuquerque, Brandão, Gerlack, Pereira, Barros, Andrade, Bastos, Azevedo, Carreiro, Barreto and Santos. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
de Castro, Caroline Tianeze
de Queiroz, Mariana Jorge
Albuquerque, Flavia Caixeta
Brandão, Celmário Castro
Gerlack, Leticia Farias
Pereira, Daniella Cristina Rodrigues
Barros, Sandra Castro
Andrade, Wenderson Walla
Bastos, Ediane de Assis
Azevedo, Jessé de Nobrega Batista
Carreiro, Roberto
Barreto, Mauricio Lima
dos Santos, Djanilson Barbosa
Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title_full Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title_fullStr Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title_full_unstemmed Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title_short Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis
title_sort real-world effectiveness of biological therapy in patients with rheumatoid arthritis: systematic review and meta-analysis
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9402894/
https://www.ncbi.nlm.nih.gov/pubmed/36034836
http://dx.doi.org/10.3389/fphar.2022.927179
work_keys_str_mv AT decastrocarolinetianeze realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT dequeirozmarianajorge realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT albuquerqueflaviacaixeta realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT brandaocelmariocastro realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT gerlackleticiafarias realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT pereiradaniellacristinarodrigues realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT barrossandracastro realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT andradewendersonwalla realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT bastosedianedeassis realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT azevedojessedenobregabatista realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT carreiroroberto realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT barretomauriciolima realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis
AT dossantosdjanilsonbarbosa realworldeffectivenessofbiologicaltherapyinpatientswithrheumatoidarthritissystematicreviewandmetaanalysis