REVIEW--COMPARATIVE EFFICACY AND TOXICITY OF SECOND LINE DRUGS FOR RA

类风湿性关节炎（RA）的二线药物治疗是基于 随着时间的推移和临床判断而引入的药物。 出现 几乎没有科学证据表明这些药物在治疗糖尿病方面的相对疗效或毒性。 部分原因是大多数比较性试验规模太小， 差异 此外，虽然有人建议， 患者亚组（例如，近期发病的患者）的反应更好 二线药物比其他药物，几乎没有证据支持 反应的亚组差异。 本研究的总体目标是使用原始数据和已发表的数据 从临床试验中评估治疗的有效性和毒性 对于RA。 该项目有两个组成部分， 该数据是患者特异性的，并且是一项已发表的试验荟萃分析， 研究治疗组。 这两个部分都建立在我们以前的工作基础上。 首先，我们将使用来自RA试验的原始数据的发展数据， 关于个体患者对第二次 毒品 这包括两个具体目标：第一，我们将调查 在包括轻度糖尿病患者在内的患者亚组中的药物疗效和毒性 疾病和那些最近发病的疾病;第二，我们将执行意图 对所有分析进行处理，以确定所有患者 进入试验改善。 该项目的第二部分涉及扩大我们的 已发表的RA临床试验的荟萃分析。 我们将追捕三名 具体目标：首先，我们将评估疗效，毒性和 二线药物的治疗指数我们以前没有研究过， 包括联合治疗和环孢素;第二，我们将收集 关于既往研究药物的其他信息，包括 甲氨蝶呤和柳氮磺胺吡啶;第三，我们将比较传统的 元分析方法与我们的新方法。 该项目的结果将提供有关 二线药物治疗RA的价值。 随着定期更新，我们将测试新的 介绍了药物，看看他们如何与传统的， 数据存档，我们将评估不同类型的患者是否有反应 与这些药物不同。

Second line drug therapy for rheumatoid arthritis (RA) has evolved based on the drugs introduced over time and on clinical judgement. There has been little scientific evidence of these drugs' relative efficacy or toxicity in part because most comparative trials have been too small to detect differences. Furthermore, while it has been suggested that certain subgroups of patients (e.g. those with recent onset disease) respond better to second line drugs than others, there has been little evidence supporting subgroup differences in response. The general objective of this study is to use raw data and published data from clinical trials to evaluate the efficacy and toxicity of treatments for RA. There are two components of this project, a raw data archive in which data is patient specific and a published trial metaanalysis in which the treatment group is studied. Both components build on our prior work. First, we will use our developing data of raw data from RA trials to ask a series of questions about the response of individual patients to second line drugs. This includes two specific aims: first, we will investigate drug efficacy and toxicity in subsets of patients including those with mild disease and those with recent onset disease; second, we will perform intent to treat all analyses to determine the extent to which all patients entering into trials improved. The second component of this project involves an expansion of our metaanalysis of published clinical trials in RA. We will pursue three specific aims: first, we will evaluate the efficacy, toxicity and therapeutic indexes for second line drugs we have not previously studied, including combination therapy and cyclosporine; second, we will gather additional information about previously studied drugs including methotrexate and sulfasalazine; third, we will compare the traditional metaanalytic method with our novel approach. The results of this project will provide new information on the relative value of second line drugs in RA. With regular updates, we will test newly introduced drugs to see how they compare with traditional ones and with the data archive, we will evaluate whether different types of patients respond differently to these drugs.