Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis : a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: To summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA.
METHODS: PubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised.
RESULTS: Two hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias.
CONCLUSIONS: This SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
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| Enthalten in: |
RMD open - 7(2021), 1 vom: 12. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Roodenrijs, Nadia M T [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 31.08.2021 Date Revised 16.02.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1136/rmdopen-2020-001512 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM319834727 |
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| 041 | |a eng | ||
| 100 | 1 | |a Roodenrijs, Nadia M T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis |b a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 31.08.2021 | ||
| 500 | |a Date Revised 16.02.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVES: To summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA | ||
| 520 | |a METHODS: PubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised | ||
| 520 | |a RESULTS: Two hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias | ||
| 520 | |a CONCLUSIONS: This SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a arthritis | |
| 650 | 4 | |a biological therapy | |
| 650 | 4 | |a occupational therapy | |
| 650 | 4 | |a patient reported outcome measures | |
| 650 | 4 | |a rheumatoid | |
| 650 | 4 | |a therapeutics | |
| 650 | 7 | |a Antirheumatic Agents |2 NLM | |
| 650 | 7 | |a Biological Products |2 NLM | |
| 650 | 7 | |a Tumor Necrosis Factor-alpha |2 NLM | |
| 700 | 1 | |a Hamar, Attila |e verfasserin |4 aut | |
| 700 | 1 | |a Kedves, Melinda |e verfasserin |4 aut | |
| 700 | 1 | |a Nagy, György |e verfasserin |4 aut | |
| 700 | 1 | |a van Laar, Jacob M |e verfasserin |4 aut | |
| 700 | 1 | |a van der Heijde, Désirée |e verfasserin |4 aut | |
| 700 | 1 | |a Welsing, Paco M J |e verfasserin |4 aut | |
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