Little evidence suggests clear superiority of any drug class in rheumatoid arthritis
Click Here to Manage Email Alerts
Key takeaways:
- Most of the studies compared TNF inhibitors with non-TNF-inhibitor DMARDs.
- The results may indicate that individual drug or drug class are less important than tailoring treatment strategies to the patient.
Little evidence suggests that any specific biologic or targeted synthetic disease-modifying antirheumatic drug is superior to another for rheumatoid arthritis, highlighting the importance of individualized treatment, according to data.
“A changing treatment landscape over the past 20 years has led to the availability of a wide array of therapeutic agents with varying targets,” Jeffrey A. Sparks, MD, MMSc, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote in Seminars in Arthritis and Rheumatism. “... [Randomized controlled trials (RCTs)] evaluating the efficacy and safety of [biologic/targeted synthetic DMARDs (b/tsDMARDs)] in patients with RA rarely include direct head-to-head trials between different agents. Additionally, prior studies have shown that 84-93% of patients with RA seen in clinical practice would not be eligible for inclusion in RCTs.
“Thus, participants of RCTs are not representative of the general clinical RA population,” they added. “While non-randomized studies conducted in real-life clinical settings are at risk of bias through sample selection, data collection, and analysis, such real-world data can nevertheless provide valuable insights, augmenting data from RCTs and providing important information from routine clinical practice.”
To investigate the comparative effectiveness of various therapies and mechanisms of action used for RA, Sparks and colleagues conducted a systematic literature review of studies conducted from Jan. 1, 2001, though Nov. 11, 2021, in the Medline and Embase databases. The analysis included prospective or real-world studies with 100 or more participants that used information from national databases.
To compare outcomes, the researchers considered 11 disease activity scoring systems, including Clinical Disease Activity Index (CDAI), Disease Activity Score (DAS), DAS28 using erythrocyte sedimentation rate or C-reactive protein, and the Simplified Disease Activity Index. They also included information on patient-reported outcomes from these studies.
In all, the analysis included 67 studies. Among these, 60 studies were conducted between 2011 and 2021, while 60 were multicenter observational or registry studies. The most common comparison between drug types — assessed in 35 studies — was TNF inhibitors vs. non-TNF-inhibitor biologic DMARDs. According to the researchers, the data revealed “no evident differences” between the biologic or targeted synthetic DMARDs in clinical effectiveness for RA.
“This systematic review represents one of the largest datasets of its kind, summarizing 20 years of studies on the relative effectiveness of b/tsDMARDs in patients with RA conducted in a clinical practice setting, allowing us to start building a qualitative picture of global real world comparative effectiveness research,” Sparks and colleagues wrote.
They added: “We found there are many effective options for the treatment of RA; however, there was relatively less evidence to support the use of any single b/tsDMARD or [mechanism of action] over another, supporting the consensus of current treatment guidelines that the individual drug or drug class is perhaps less important than tailoring treatment strategies to the individual patient.”
Perspective
Back to Top
Which medication is the most appropriate for this patient? That’s a loaded question! Some providers have their “go-to” medications they always start with for their patients with rheumatoid arthritis. You know those medications; the ones you are comfortable with and have used for years. However, what about all the new mechanisms of action and the biosimilars?
There is a silver lining here. Sparks and colleagues analyzed studies using real-world patients and compared the effectiveness of different treatments, head-to-head, allowing for personalized treatment plans and a greater likelihood of success while minimizing side effects.
If we can identify the most efficient medications early on, patients are less likely to endure lengthy trial and error processes, which can help reduce health care costs. We need to continue to invest in this type of research, which will ultimately lead to better patient outcomes.
Collapse
Read more about
Click Here to Manage Email Alerts