scholarly journals Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review

Rheumatology ◽  
2002 ◽  
Vol 41 (12) ◽  
pp. 1346-1356 ◽  
Author(s):  
T. Pincus
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Observational Studies ◽  
Radiographic Progression ◽  
Disease Modifying

scholarly journals Markers for type II collagen breakdown predict the effect of disease-modifying treatment on long-term radiographic progression in patients with rheumatoid arthritis

2004 ◽  
Vol 50 (5) ◽  
pp. 1390-1399 ◽  
Author(s):  
Robert Landewé ◽  
Piet Geusens ◽  
Maarten Boers ◽  
Désirée van der Heijde ◽  
Willem Lems ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Radiographic Progression ◽  
Type Ii Collagen ◽  
Type Ii ◽  
Disease Modifying ◽  
Disease Modifying Treatment

scholarly journals FRI0598 DMARD-FREE REMISSION IN RHEUMATOID ARTHRITIS: AN ACHIEVABLE AND SUSTAINABLE OUTCOME? A SYSTEMATIC LITERATURE REVIEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 905.1-905
Author(s):  
M. Verstappen ◽  
E. Van Mulligen ◽  
P. De Jong ◽  
A. Van der Helm - van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Observational Studies ◽  
Literature Search ◽  
Primary Outcome ◽  
Patient Characteristics ◽  
High Rate ◽  
First Year ◽  
Sustained Remission ◽  
Disease Modifying

Background:Current treatment guidelines for rheumatoid arthritis (RA) suggest tapering DMARDs.1Discontinuation of DMARD-treatment is of increasing interest, and DMARD-free remission (DFR) is regarded an important future outcome.2 3However, lack of knowledge on DFR prevalence, its sustainability, and the characteristics of patients achieving DFR currently hampers the use of DFR as primary outcome.Objectives:To increase the understanding of DFR in RA, and to support studies aiming to include this as primary outcome, we systematically reviewed the literature to determine prevalence and sustainability of DFR. Potential predictors of DFR were evaluated to increase insight in patient characteristics favourable for achieving this outcome.Methods:A systematic literature search was performed in March 2019 in multiple databases. All clinical trials and observational studies reporting on discontinuation of DMARDs in RA-patients in remission were included. Our quality assessment included a general assessment and assessment of the description of DFR. Prevalence of DFR and its sustainability, flares during tapering and after DMARD-stop were summarized. Also, potential predictors of achieving DFR were reviewed.Results:From 631 articles, 51 were included, comprising 14 clinical trials and 5 observational studies. DFR-definition differed, especially for the duration of DMARD-free state. Considering only high and moderate-quality studies, DFR was achieved in 5.0%-24.3%, and sustained DFR (duration>12 months) in 11.6%-19.4%. Flares occurred frequently during DMARD-tapering (41.8%-75.0%) and in the first year after achieving DFR (10.4%-11.8%), whilst late flares, >1 year after DMARD-stop, were infrequent (0.3%-3.5%). Many patient characteristics lacked association with DFR. Absence of auto-antibodies and shared epitope alleles increased the risk of achieving DFR.Conclusion:DFR is achievable in RA, and is sustainable in ~10%-20% of patients.1DFR can become an important outcome measure for clinical trials, and requires consistency in the definition. Considering the high rate of flares in the first year after DMARD-stop, a DMARD-free follow-up of >12 months is advisable to evaluate sustainability.References:[1] Smolen JS, Landewe R, Bijlsma Jea. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.Ann Rheum Dis2017;76(6):960-77. doi: annrheumdis-2016-210715 [pii];10.1136/annrheumdis-2016-210715 [doi][2] Ajeganova S, van Steenbergen HW, van Nies JA, et al. Disease-modifying antirheumatic drug-free sustained remission in rheumatoid arthritis: an increasingly achievable outcome with subsidence of disease symptoms.Ann Rheum Dis2016;75(5):867-73. doi: annrheumdis-2014-207080 [pii];10.1136/annrheumdis-2014-207080 [doi][3] Stamm TA, Machold KP, Aletaha D, et al. Induction of sustained remission in early inflammatory arthritis with the combination of infliximab plus methotrexate: the DINORA trial.Arthritis Res Ther2018;20(1):174. doi: 10.1186/s13075-018-1667-z [doi];10.1186/s13075-018-1667-z [pii]Acknowledgments:We would like to thank J. Schoones, librarian of Leiden University Medical Center, for constructing and carrying out the literature search.Disclosure of Interests:None declared

scholarly journals EULAR points to consider for conducting clinical trials and observational studies in individuals at risk of rheumatoid arthritis

2021 ◽  
pp. annrheumdis-2021-220884
Author(s):  
Kulveer Mankia ◽  
Heidi J Siddle ◽  
Andreas Kerschbaumer ◽  
Deshire Alpizar Rodriguez ◽  
Anca Irinel Catrina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
At Risk ◽  
Clinical Trials ◽  
Observational Studies ◽  
Task Force ◽  
Musculoskeletal Symptoms ◽  
Subclinical Inflammation ◽  
Consensus Statements ◽  
Clinical Arthritis

BackgroundDespite growing interest, there is no guidance or consensus on how to conduct clinical trials and observational studies in populations at risk of rheumatoid arthritis (RA).MethodsAn European League Against Rheumatism (EULAR) task force formulated four research questions to be addressed by systematic literature review (SLR). The SLR results informed consensus statements. One overarching principle, 10 points to consider (PTC) and a research agenda were proposed. Task force members rated their level of agreement (1–10) for each PTC.ResultsEpidemiological and demographic characteristics should be measured in all clinical trials and studies in at-risk individuals. Different at-risk populations, identified according to clinical presentation, were defined: asymptomatic, musculoskeletal symptoms without arthritis and early clinical arthritis. Study end-points should include the development of subclinical inflammation on imaging, clinical arthritis, RA and subsequent achievement of arthritis remission. Risk factors should be assessed at baseline and re-evaluated where appropriate; they include genetic markers and autoantibody profiling and additionally clinical symptoms and subclinical inflammation on imaging in those with symptoms and/or clinical arthritis. Trials should address the effect of the intervention on risk factors, as well as progression to clinical arthritis or RA. In patients with early clinical arthritis, pharmacological intervention has the potential to prevent RA development. Participants’ knowledge of their RA risk may inform their decision to participate; information should be provided using an individually tailored approach.ConclusionThese consensus statements provide data-driven guidance for rheumatologists, health professionals and investigators conducting clinical trials and observational studies in individuals at risk of RA.

scholarly journals New insights and long-term safety of tocilizumab in rheumatoid arthritis

2018 ◽  
Vol 10 (10) ◽  
pp. 195-199 ◽  
Author(s):  
Graeme Jones ◽  
Elena Panova
Keyword(s):  
Rheumatoid Arthritis ◽  
Observational Studies ◽  
Randomized Trials ◽  
Treatment Options ◽  
Safety Data ◽  
Signs And Symptoms ◽  
Western Society ◽  
Interleukin 6 Receptor ◽  
Term Data

Rheumatoid arthritis is a leading musculoskeletal cause of disability in Western society. Therapeutic options have expanded rapidly with the advent of biological agents as treatment options. One of these, tocilizumab, targets the interleukin-6 receptor and has been approved since the late 2000s in many jurisdictions. This approval was based on 6–12 month trials. It is now appropriate to look at longer-term studies and what new insights they have provided into this agent. Data are based largely on observational studies with their well-known limitations as well as some further randomized trials and provide a number of important observations regarding both efficacy and safety. In conclusion, the longer-term data suggest tocilizumab efficacy increases over time for both signs and symptoms and radiographic change. It is also corticosteroid sparing. The safety data are consistent with the shorter-term trials and are largely reassuring but some questions still remain over cardiovascular safety and cancer risk.

Disease modifying anti-rheumatic drugs, biologics and corticosteroid use in older patients with rheumatoid arthritis over 20 years

2020 ◽  
pp. jrheum.200310
Author(s):  
John G. Hanly ◽  
Lynn Lethbridge
Keyword(s):  
Rheumatoid Arthritis ◽  
Secondary Analysis ◽  
Case Definition ◽  
Prescribing Patterns ◽  
Annual Dose ◽  
Pharmacological Management ◽  
Health Administrative Data ◽  
Disease Modifying ◽  
Universal Health

Objective To examine changes in prescribing patterns, especially the use of corticosteroids, in patients with rheumatoid arthritis (RA) over two decades. Methods This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017. Results There were 8240 RA cases (all ≥ 65 years) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease modifying anti-rheumatic drugs (DMARDs) and biologics. Over the same period corticosteroid use was largely unchanged. Approximately one third of patients had at least one annual prescription for corticosteroid, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed corticosteroids less frequently and in lower doses than other physician groups. For incident RA cases there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time. Conclusion In older adults with RA the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of corticosteroids has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.

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