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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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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 |
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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 |
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