Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis
Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis
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DOI：
10.1136/annrheumdis-2013-204577
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发表时间：
2014-03-01
影响因子：
27.4
通讯作者：
Buch, Maya H.
中科院分区：
文献类型：
--
作者：
Nam, Jackie L.;Ramiro, Sofia;Buch, Maya H.
目的更新生物疾病缓解抗风湿药物（bDMARD）治疗类风湿关节炎（RA）的疗效证据，为欧洲抗风湿联盟（EULAR）工作组提供治疗建议。方法检索Medline、Embase和科克伦数据库，检索2009年1月至2013年2月发表的关于英夫利昔单抗、依那西普、阿达木单抗、赛妥珠单抗-聚乙二醇、戈利木单抗、阿那白滞素、阿巴西普、利妥昔单抗、托珠单抗和生物仿制药DMARD（bsDMARD）处于3期开发阶段。结果共检索到全文51篇，文摘57篇。随机对照试验（RCT）证实了bDMARD+常规合成DMARD（csDMARD）与单独使用csDMARD相比的疗效（1B级证据）。有一些额外的证据表明使用bDMARD单药治疗，但bDMARD和MTX联合治疗对所有bDMARD类别更有效（1B）。达标治疗策略的临床和影像学应答率较高。早期症状和体征的改善与更密集的初始治疗策略，但结果是相似的bDMARDs后，对MTX反应不足的患者。一般而言，使用bDMARD的放射学进展较低，主要是由于初始治疗效应。虽然患者可能达到bDMARD和无药物缓解，但bDMARD继续治疗的临床应答维持率较高（1B），但可以降低bDMARD剂量（1B）。仍然没有RCT数据bDMARD switching.Conclusions系统的文献综述证实了生物DMARDs在RA中的疗效。它解决了不同的治疗策略，减少治疗的潜力，特别是与早期疾病控制，并强调新兴疗法。
Objectives To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA) to inform the European League Against Rheumatism(EULAR) Task Force treatment recommendations.Methods Medline, Embase and Cochrane databases were searched for articles published between January 2009 and February 2013 on infliximab, etanercept, adalimumab, certolizumab-pegol, golimumab, anakinra, abatacept, rituximab, tocilizumab and biosimilar DMARDs (bsDMARDs) in phase 3 development. Abstracts from 2011 to 2012 American College of Rheumatology (ACR) and 2011-2013 EULAR conferences were obtained.Results Fifty-one full papers, and 57 abstracts were identified. The randomised controlled trials (RCT) confirmed the efficacy of bDMARD+conventional synthetic DMARDs (csDMARDs) versus csDMARDs alone (level 1B evidence). There was some additional evidence for the use of bDMARD monotherapy, however bDMARD and MTX combination therapy for all bDMARD classes was more efficacious (1B). Clinical and radiographic responses were high with treat-to-target strategies. Earlier improvement in signs and symptoms were seen with more intensive initial treatment strategies, but outcomes were similar upon addition of bDMARDs in patients with insufficient response to MTX. In general, radiographic progression was lower with bDMARD use, mainly due to initial treatment effects. Although patients may achieve bDMARD- and drug-free remission, maintenance of clinical responses was higher with bDMARD continuation (1B), but bDMARD dose reduction could be applied (1B). There was still no RCT data for bDMARD switching.Conclusions The systematic literature review confirms efficacy of biological DMARDs in RA. It addresses different treatment strategies with the potential for reduction in therapy, particularly with early disease control, and highlights emerging therapies.