Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec 29;12(1):286.
doi: 10.3390/jcm12010286.

Comparison of Biological Agent Monotherapy and Associations Including Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis: Literature Review and Meta-Analysis of Randomized Trials

Célia Delpech  1 , François-Xavier Laborne  2 , Pascal Hilliquin  1
Affiliations
Review

Comparison of Biological Agent Monotherapy and Associations Including Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis: Literature Review and Meta-Analysis of Randomized Trials

Célia Delpech et al. J Clin Med. .

Abstract

Objective: Update the available evidence comparing biologic disease-modifying antirheumatic drugs (bDMARDs) in combination with conventional synthetic disease-modifying antirheumatic drugs (CsDMARDs) to bDMARDs in monotherapy in patients with rheumatoid arthritis.

Methods: Research was limited to randomized controlled trials. Major outcome: ACR 20 response criteria at 24 weeks.

Secondary outcomes: clinical and radiographic criteria at week 24, 52 and 104.

Results: 23 trials (6358 patients), including seven bDMARDs and one other molecule: Anbainuo (anti-TNF-R). No study satisfied our search criteria for anakinra, certolizumab and infliximab. Compared to bDMARD monotherapy, combination therapy gives a better ACR 20 at 24 weeks (RR: 0.88 (0.84-0.94)) in fixed and random effect models, and this result is sustained at 52 and 104 weeks. The results were mostly similar for all other outcomes without increasing the risk of adverse effects.

Conclusion: This meta-analysis confirms the superiority of combination therapy over monotherapy in rheumatoid arthritis, in accordance to the usual guidelines.

Keywords: DMARDs (synthetic); biologic agents; meta-analysis; rheumatoid arthritis; systematic reviews.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Assessment of the risk of bias. The Cochrane Collaboration tool used for randomized trials.
Figure 2
Figure 2
Flow diagram for study inclusion/exclusion. CsDMARDs: Conventional synthetic disease-modifying anti-rheumatic drugs; bDMARDs: Biological disease-modifying anti-rheumatic drugs; VS: versus.
Figure 3
Figure 3
ACR 20 responses at week 24.
Figure 4
Figure 4
DAS 28–ESR remission at 52 weeks.
Figure 5
Figure 5
Sharp remission at 52 weeks.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gabriel S.E., Crowson C.S., O’Fallon W.M. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum. 1999;42:415–420. doi: 10.1002/1529-0131(199904)42:3<415::AID-ANR4>3.0.CO;2-Z. - DOI - PubMed
    1. Daien C., Hua C., Gaujoux-Viala C., Cantagrel A., Dubremetz M., Dougados M., Fautrel B., Mariette X., Nayral N., Richez C., et al. Update of the Recommendations of the French Society of Rheumatology for the 340 Management of Rheumatoid Arthritis. Jt. Bone Spine. 2019;86:135–150. doi: 10.1016/j.jbspin.2018.10.002. - DOI - PubMed
    1. Smolen J.S., Landewé R.B.M., Bijlsma J.W.J., Burmester G.R., Dougados M., Kerschbaumer A., McInnes I.B., Sepriano A., van Vollenhoven R.F., de Wit W., et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann. Rheum. Dis. 2020;79:685–699. doi: 10.1136/annrheumdis-2019-216655. - DOI - PubMed
    1. Smolen J.S., Landewé R., Bijlsma J., Burmester G., Chatzidionysiou K., Dougados M., Nam J., Ramiro S., Voshaar M., van Vollenhoven R., et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis. 2017;76:960–977. doi: 10.1136/annrheumdis-2016-210715. - DOI - PubMed
    1. Soliman M.M., Ashcroft D.M., Watson K.D., Lunt M., Symmons D.P., Hyrich K.L. Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register. Ann. Rheum. Dis. 2011;70:583–589. doi: 10.1136/ard.2010.139774. - DOI - PMC - PubMed

LinkOut - more resources