Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: A systematic literature review informing the EULAR recommendations for the management of RA

J. L. Nam, Kevin Winthrop, R. F. Van Vollenhoven, K. Pavelka, G. Valesini, E. M A Hensor, G. Worthy, R. Landewé, J. S. Smolen, P. Emery, Maya H. Buch

Research output: Contribution to journalArticle

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Abstract

Objectives: To review the evidence for the efficacy and safety of biological agents in patients with rheumatoid arthritis (RA) to provide data to develop treatment recommendations by the European League Against Rheumatism (EULAR) Task Force. Methods: Medline, Embase and Cochrane databases were searched for relevant articles on infliximab (IFX), etanercept (ETN), adalimumab (ADA), certolizumab-pegol (CZP), golimumab (GLM), anakinra (ANA), abatacept (ABT), rituximab (RTX) and tocilizumab (TCZ) published between 1962 and February 2009; published abstracts from the 2007-2008 American College of Rheumatology (ACR) and EULAR conference were obtained. Results: 87 articles and 40 abstracts were identified. In methotrexate (MTX) naïve patients, biological therapy with IFX, ETN, ADA, GLM or ABT has been shown to improve clinical outcomes (level of evidence 1B). In MTX/other synthetic disease-modifying antirheumatic drug (DMARD) failures all nine biological agents confer benefit (1B), with lower efficacy noted for ANA. RTX, ABT, TCZ and GLM demonstrate efficacy in tumour necrosis factor inhibitor (TNFi) failures (1B). Less evidence exists for switching between IFX, ETN and ADA (3B). Biological and MTX combination therapy is more efficacious than a biological agent alone (1B). A safety review shows no increased malignancy risk compared with conventional DMARDs (3B). TNfiare generally associated with an increased risk of serious bacterial infection, particularly within the first 6 months of treatment initiation; increased tuberculosis (TB) rates with TNfiare highest with the monoclonal antibodies (3B). Conclusions: There is good evidence for the efficacy of biological agents in patients with RA. Safety data confirm an increased risk of bacterial infection and TB with TNFi compared with conventional DMARDs.

Original languageEnglish (US)
Pages (from-to)976-986
Number of pages11
JournalAnnals of the Rheumatic Diseases
Volume69
Issue number6
DOIs
StatePublished - Jun 2010

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Antirheumatic Agents
Biological Factors
Rheumatic Diseases
Rheumatoid Arthritis
Methotrexate
Interleukin 1 Receptor Antagonist Protein
Safety
Bacterial Infections
Tuberculosis
Tumor Necrosis Factor-alpha
Biological Therapy
Advisory Committees
Therapeutics
Monoclonal Antibodies
Databases
Infliximab
golimumab
Etanercept
Adalimumab
Abatacept

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs : A systematic literature review informing the EULAR recommendations for the management of RA. / Nam, J. L.; Winthrop, Kevin; Van Vollenhoven, R. F.; Pavelka, K.; Valesini, G.; Hensor, E. M A; Worthy, G.; Landewé, R.; Smolen, J. S.; Emery, P.; Buch, Maya H.

In: Annals of the Rheumatic Diseases, Vol. 69, No. 6, 06.2010, p. 976-986.

Research output: Contribution to journalArticle

Nam, J. L. ; Winthrop, Kevin ; Van Vollenhoven, R. F. ; Pavelka, K. ; Valesini, G. ; Hensor, E. M A ; Worthy, G. ; Landewé, R. ; Smolen, J. S. ; Emery, P. ; Buch, Maya H. / Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs : A systematic literature review informing the EULAR recommendations for the management of RA. In: Annals of the Rheumatic Diseases. 2010 ; Vol. 69, No. 6. pp. 976-986.
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abstract = "Objectives: To review the evidence for the efficacy and safety of biological agents in patients with rheumatoid arthritis (RA) to provide data to develop treatment recommendations by the European League Against Rheumatism (EULAR) Task Force. Methods: Medline, Embase and Cochrane databases were searched for relevant articles on infliximab (IFX), etanercept (ETN), adalimumab (ADA), certolizumab-pegol (CZP), golimumab (GLM), anakinra (ANA), abatacept (ABT), rituximab (RTX) and tocilizumab (TCZ) published between 1962 and February 2009; published abstracts from the 2007-2008 American College of Rheumatology (ACR) and EULAR conference were obtained. Results: 87 articles and 40 abstracts were identified. In methotrexate (MTX) na{\"i}ve patients, biological therapy with IFX, ETN, ADA, GLM or ABT has been shown to improve clinical outcomes (level of evidence 1B). In MTX/other synthetic disease-modifying antirheumatic drug (DMARD) failures all nine biological agents confer benefit (1B), with lower efficacy noted for ANA. RTX, ABT, TCZ and GLM demonstrate efficacy in tumour necrosis factor inhibitor (TNFi) failures (1B). Less evidence exists for switching between IFX, ETN and ADA (3B). Biological and MTX combination therapy is more efficacious than a biological agent alone (1B). A safety review shows no increased malignancy risk compared with conventional DMARDs (3B). TNfiare generally associated with an increased risk of serious bacterial infection, particularly within the first 6 months of treatment initiation; increased tuberculosis (TB) rates with TNfiare highest with the monoclonal antibodies (3B). Conclusions: There is good evidence for the efficacy of biological agents in patients with RA. Safety data confirm an increased risk of bacterial infection and TB with TNFi compared with conventional DMARDs.",
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AU - Nam, J. L.

AU - Winthrop, Kevin

AU - Van Vollenhoven, R. F.

AU - Pavelka, K.

AU - Valesini, G.

AU - Hensor, E. M A

AU - Worthy, G.

AU - Landewé, R.

AU - Smolen, J. S.

AU - Emery, P.

AU - Buch, Maya H.

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N2 - Objectives: To review the evidence for the efficacy and safety of biological agents in patients with rheumatoid arthritis (RA) to provide data to develop treatment recommendations by the European League Against Rheumatism (EULAR) Task Force. Methods: Medline, Embase and Cochrane databases were searched for relevant articles on infliximab (IFX), etanercept (ETN), adalimumab (ADA), certolizumab-pegol (CZP), golimumab (GLM), anakinra (ANA), abatacept (ABT), rituximab (RTX) and tocilizumab (TCZ) published between 1962 and February 2009; published abstracts from the 2007-2008 American College of Rheumatology (ACR) and EULAR conference were obtained. Results: 87 articles and 40 abstracts were identified. In methotrexate (MTX) naïve patients, biological therapy with IFX, ETN, ADA, GLM or ABT has been shown to improve clinical outcomes (level of evidence 1B). In MTX/other synthetic disease-modifying antirheumatic drug (DMARD) failures all nine biological agents confer benefit (1B), with lower efficacy noted for ANA. RTX, ABT, TCZ and GLM demonstrate efficacy in tumour necrosis factor inhibitor (TNFi) failures (1B). Less evidence exists for switching between IFX, ETN and ADA (3B). Biological and MTX combination therapy is more efficacious than a biological agent alone (1B). A safety review shows no increased malignancy risk compared with conventional DMARDs (3B). TNfiare generally associated with an increased risk of serious bacterial infection, particularly within the first 6 months of treatment initiation; increased tuberculosis (TB) rates with TNfiare highest with the monoclonal antibodies (3B). Conclusions: There is good evidence for the efficacy of biological agents in patients with RA. Safety data confirm an increased risk of bacterial infection and TB with TNFi compared with conventional DMARDs.

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