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Triple Oral Therapy Versus Antitumor Necrosis Factor Plus Methotrexate (MTX) in Patients with Rheumatoid Arthritis and Inadequate Response to MTX: A Systematic Literature Review
- Source :
- Journal of Rheumatology, Journal of Rheumatology, Journal of Rheumatology Publishing Company Limited, 2017, 44 (6), pp.773-779. ⟨10.3899/jrheum.160643⟩, Journal of Rheumatology, Journal of Rheumatology Publishing Company Limited, 2017, 44 (6), pp.773-779. 〈10.3899/jrheum.160643〉
- Publication Year :
- 2017
- Publisher :
- The Journal of Rheumatology, 2017.
-
Abstract
- Objective.For patients with rheumatoid arthritis (RA) who have an inadequate response to methotrexate (MTX), the relative effectiveness of the combination of conventional disease-modifying antirheumatic drugs (DMARD) compared with the combination of tumor necrosis factor (TNF) inhibitors and MTX, as second-line therapy, is uncertain. The aim of this study was to compare the efficacy and tolerance of triple oral DMARD therapy versus anti-TNF agents associated with MTX in patients with RA after MTX failure.Methods.We performed a systematic search of the literature up to November 2015 in MEDLINE, Embase, the Cochrane library, and abstracts from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) meetings from 2006 to 2015. Articles were included if they were of randomized controlled trials of patients receiving triple oral combination therapy (TT; MTX + sulfasalazine + hydroxychloroquine) compared with anti-TNF agents plus MTX. Treatment effects were examined by disease activity [Disease Activity Score in 28 joints (DAS28)], ACR and EULAR response criteria, structural damage by the modified total Sharp score, and functional disability by the Health Assessment Questionnaire (HAQ).Results.Our search identified 263 articles; only 5 fulfilled the selection criteria. Analysis of ACR and EULAR response criteria, DAS28, and modified Sharp scores favored anti-TNF agents combined with MTX. Functional disability (HAQ) and rates of adverse events did not differ between treatments.Conclusion.In patients with RA in whom MTX has failed, the addition of a TNF antagonist to MTX may be a valid option, with better clinical outcomes and better radiographic results in the presence of poor prognostic factors. In the absence of poor prognostic factors and/or with contraindications to biologic agents, TT retains its place in the therapeutic strategy for RA in a currently restricted economic context.
- Subjects :
- musculoskeletal diseases
medicine.medical_specialty
Combination therapy
TNF INHIBITORS
Immunology
Pharmacology
law.invention
Arthritis, Rheumatoid
[ SDV.MHEP.RSOA ] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
03 medical and health sciences
0302 clinical medicine
Rheumatology
Randomized controlled trial
immune system diseases
Sulfasalazine
law
Internal medicine
medicine
Humans
Immunology and Allergy
heterocyclic compounds
030212 general & internal medicine
skin and connective tissue diseases
Adverse effect
RHEUMATOID ARTHRITIS
TRIPLE THERAPY
030203 arthritis & rheumatology
Biological Products
Tumor Necrosis Factor-alpha
business.industry
CONVENTIONAL TREATMENT
Hydroxychloroquine
medicine.disease
3. Good health
DMARD
Methotrexate
Treatment Outcome
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Antirheumatic Agents
Rheumatoid arthritis
Drug Therapy, Combination
business
Rheumatism
medicine.drug
Subjects
Details
- ISSN :
- 14992752 and 0315162X
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- The Journal of Rheumatology
- Accession number :
- edsair.doi.dedup.....9cb258824b0a6973eeb9cb67f3d61318