Medical University of Vienna, Vienna, Austria
Leiden University Medical Center, Leiden, The Netherlands.
Ann Rheum Dis. 2020 Jun;79(6):744-759. doi: 10.1136/annrheumdis-2019-216656. Epub 2020 Feb 7.
To inform the 2019 update of the European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA).
A systematic literature research (SLR) to investigate the efficacy of any disease-modifying antirheumatic drug (DMARD) (conventional synthetic (cs)DMARD, biological (b) and biosimilar DMARD, targeted synthetic (ts)DMARD) or glucocorticoid (GC) therapy in patients with RA was done by searching MEDLINE, Embase and the Cochrane Library for articles published between 2016 and 8 March 2019.
234 abstracts were selected for detailed assessment, with 136 finally included. They comprised the efficacy of bDMARDs versus placebo or other bDMARDs, efficacy of Janus kinase (JAK) inhibitors (JAKi) across different patient populations and head-to-head of different bDMARDs versus JAKi or other bDMARDs. Switching of bDMARDs to other bDMARDs or tsDMARDs, strategic trials and tapering studies of bDMARDs, csDMARDs and JAKi were assessed. The drugs evaluated included abatacept, adalimumab, ABT-122, baricitinib, certolizumab pegol, SBI-087, CNTO6785, decernotinib, etanercept, filgotinib, golimumab, GCs, GS-9876, guselkumab, hydroxychloroquine, infliximab, leflunomide, mavrilimumab, methotrexate, olokizumab, otilimab, peficitinib, rituximab, sarilumab, salazopyrine, secukinumab, sirukumab, tacrolimus, tocilizumab, tofacitinib, tregalizumab, upadacitinib, ustekinumab and vobarilizumab. The efficacy of many bDMARDs and tsDMARDs was shown. Switching to another tumour necrosis factor inhibitor (TNFi) or non-TNFi bDMARDs after TNFi treatment failure is efficacious. Tapering of DMARDs is possible in patients achieving long-standing stringent clinical remission; in patients with residual disease activity (including patients in LDA) the risk of flares is increased during the tapering. Biosimilars are non-inferior to their reference products.
This SLR informed the task force regarding the evidence base of various therapeutic regimen for the development of the update of EULAR's RA management recommendation.
为 2019 年更新欧洲抗风湿病联盟（EULAR）类风湿关节炎（RA）管理建议提供信息。
通过检索 MEDLINE、Embase 和 Cochrane 图书馆，对 2016 年至 2019 年 3 月 8 日期间发表的文章进行了系统的文献检索，以调查任何疾病修饰抗风湿药物（DMARD）（传统合成（cs）DMARD、生物（b）和生物类似物 DMARD、靶向合成（ts）DMARD）或糖皮质激素（GC）治疗 RA 患者的疗效。
共选择了 234 篇摘要进行详细评估，最终有 136 篇入选。它们包括 bDMARD 与安慰剂或其他 bDMARD 的疗效、不同患者人群中 Janus 激酶（JAK）抑制剂（JAKi）的疗效、不同 bDMARD 与 JAKi 或其他 bDMARD 的头对头比较、bDMARD 向其他 bDMARD 或 tsDMARD 的转换、bDMARD、csDMARD 和 JAKi 的策略性试验和减量研究。评估的药物包括阿巴西普、阿达木单抗、ABT-122、巴利昔单抗、certolizumab pegol、SBI-087、CNTO6785、decernotinib、依那西普、filgotinib、戈利木单抗、GCs、GS-9876、guselkumab、羟氯喹、英夫利昔单抗、来氟米特、mavrilimumab、甲氨蝶呤、奥洛昔单抗、otilimab、培非替尼、利妥昔单抗、sarilumab、柳氮磺胺吡啶、secukinumab、sirukumab、他克莫司、托珠单抗、托法替尼、tregalizumab、upadacitinib、ustekinumab 和 vobarilizumab。许多 bDMARD 和 tsDMARD 的疗效得到了证实。在 TNFi 治疗失败后，转换为另一种肿瘤坏死因子抑制剂（TNFi）或非 TNFi bDMARD 是有效的。在达到长期严格临床缓解的患者中可以减少 DMARD 的剂量；在有残留疾病活动的患者（包括处于低疾病活动度的患者）中，减量过程中会增加发作的风险。生物类似物与原研产品非劣效。
这项 SLR 为工作组提供了有关各种治疗方案的证据基础，以制定 EULAR 的 RA 管理建议的更新。
