Last Updated: 2007-11-19 17:00:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) – The results of a systematic review suggest that there is no clear-cut winner when it comes to the most effective disease-modifying antirheumatic drug (DMARD). However, combination therapy typically works better than monotherapy.
Dr. Katrina E. Donahue, from the University of North Carolina at Chapel Hill, and colleagues searched MEDLINE, EMBASE, and other sources for trials featuring a head-to-head comparison between various DMARDs. Only studies with at least 100 subjects and 12 weeks or more of follow-up were included in the analysis. Data from meta-analyses and retrospective studies were also included when primary data was lacking.
The researchers’ findings appear in the November 20th early release issue of the Annals of Internal Medicine and will be published in the January 15th print edition.
Data from more than 7200 patients were included in the drug comparison analysis, the report indicates. An analysis of data from 23 head-to-head trials revealed no significant differences in clinical efficacy among synthetic DMARDs (methotrexate, leflunomide, or sulfasalazine) or among anti-TNF agents (adalimumab, etanercept, or infliximab).
"Monotherapy with anti-tumor necrosis factor drugs resulted in better radiographic outcomes than did methotrexate but no important differences in clinical outcomes," the authors note.
Combining various biological DMARDs with methotrexate resulted in better clinical response rates and functional outcomes than did treatment with biological DMARDs or methotrexate alone. Moreover, combination therapy with synthetic DMARDs was found to improve response rates in patients whose monotherapy failed.
Adverse events with biological and synthetic DMARDs were comparable. Due to limited data, the researchers were unable to reach firm conclusions regarding the occurrence of rare but serious side effects with each agent.
"Future studies, including those with good applicability to patients seen in community practices, will be useful; researchers should plan to perform subgroup analyses a priori in older patients and patients with comorbid conditions. Long-term adverse event studies, particularly with the newer agents, will help clinicians and patients better weigh the benefits of these drugs," the researchers state.
Ann Intern Med 2007.