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Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis.
de Castro, Caroline Tianeze; de Queiroz, Mariana Jorge; Albuquerque, Flavia Caixeta; Brandão, Celmário Castro; Gerlack, Leticia Farias; Pereira, Daniella Cristina Rodrigues; Barros, Sandra Castro; Andrade, Wenderson Walla; Bastos, Ediane de Assis; Azevedo, Jessé de Nobrega Batista; Carreiro, Roberto; Barreto, Mauricio Lima; Dos Santos, Djanilson Barbosa.
Affiliation
  • de Castro CT; Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
  • de Queiroz MJ; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Albuquerque FC; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Brandão CC; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Gerlack LF; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Pereira DCR; Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
  • Barros SC; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Andrade WW; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Bastos EA; Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
  • Azevedo JNB; Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil.
  • Carreiro R; Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
  • Barreto ML; Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
  • Dos Santos DB; Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil.
Front Pharmacol ; 13: 927179, 2022.
Article in En | MEDLINE | ID: mdl-36034836
Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient's response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81-0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79-0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05-1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68-1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Language: En Journal: Front Pharmacol Year: 2022 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Language: En Journal: Front Pharmacol Year: 2022 Document type: Article Affiliation country: Country of publication: