Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

M. M.A. Verhoeven; P. M.J. Welsing; J. W.J. Bijlsma; J. M. van Laar; F. P.J.G. Lafeber; J. Tekstra; J. W.G. Jacobs

doi:10.1007/s11926-019-0821-1

Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

M. M.A. Verhoeven^*
, P. M.J. Welsing
, J. W.J. Bijlsma
, J. M. van Laar
, F. P.J.G. Lafeber
, J. Tekstra
, J. W.G. Jacobs

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

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Abstract

PURPOSE OF REVIEW: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA.

RECENT FINDINGS: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.

Original language	English
Article number	24
Journal	Current Rheumatology Reports
Volume	21
Issue number	6
DOIs	https://doi.org/10.1007/s11926-019-0821-1
Publication status	Published - 23 Apr 2019

Keywords

bDMARDs
csDMARDs
Early rheumatoid arthritis
GCs
Induction therapy
Standard care

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title = "Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review",

abstract = "PURPOSE OF REVIEW: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA.RECENT FINDINGS: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76\%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative {"}risk{"} was 1.73 [95\%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95\%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid {"}bridging therapy{"} was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95\%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.",

keywords = "bDMARDs, csDMARDs, Early rheumatoid arthritis, GCs, Induction therapy, Standard care",

author = "Verhoeven, \{M. M.A.\} and Welsing, \{P. M.J.\} and Bijlsma, \{J. W.J.\} and \{van Laar\}, \{J. M.\} and Lafeber, \{F. P.J.G.\} and J. Tekstra and Jacobs, \{J. W.G.\}",

note = "Funding Information: Dr. van Laar reports grants from Arthrogen, grants from MSD, personal fees from Pfizer, personal fees from Eli Lilly, personal fees from BMS, grants from Astra Zeneca, grants from Roche-Genentech, outside the submitted work. Publisher Copyright: {\textcopyright} 2019, The Author(s).",

year = "2019",

month = apr,

day = "23",

doi = "10.1007/s11926-019-0821-1",

language = "English",

volume = "21",

journal = "Current Rheumatology Reports",

issn = "1523-3774",

publisher = "Springer",

number = "6",

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TY - JOUR

T1 - Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis

T2 - a Systematic Literature Review

AU - Verhoeven, M. M.A.

AU - Welsing, P. M.J.

AU - Bijlsma, J. W.J.

AU - van Laar, J. M.

AU - Lafeber, F. P.J.G.

AU - Tekstra, J.

AU - Jacobs, J. W.G.

N1 - Funding Information: Dr. van Laar reports grants from Arthrogen, grants from MSD, personal fees from Pfizer, personal fees from Eli Lilly, personal fees from BMS, grants from Astra Zeneca, grants from Roche-Genentech, outside the submitted work. Publisher Copyright: © 2019, The Author(s).

PY - 2019/4/23

Y1 - 2019/4/23

N2 - PURPOSE OF REVIEW: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA.RECENT FINDINGS: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.

AB - PURPOSE OF REVIEW: To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA.RECENT FINDINGS: Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.

KW - bDMARDs

KW - csDMARDs

KW - Early rheumatoid arthritis

KW - GCs

KW - Induction therapy

KW - Standard care

UR - https://www.scopus.com/pages/publications/85064897173

U2 - 10.1007/s11926-019-0821-1

DO - 10.1007/s11926-019-0821-1

M3 - Review article

C2 - 31016409

AN - SCOPUS:85064897173

SN - 1523-3774

VL - 21

JO - Current Rheumatology Reports

JF - Current Rheumatology Reports

IS - 6

M1 - 24

ER -

Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review

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