Table ASummary of characteristics of this systematic review on treatment of patients with early rheumatoid arthritis

Population
Key Inclusion Criteria: Adult outpatients, 19 years of age or older, with an early RA diagnosis, defined as 1 year or less from disease diagnosis

Key Exclusion Criteria: Adolescents and adults with RA greater than 1 year from diagnosis
Drug Therapies Approved by FDA for RA Included in the Review
Corticosteroid: Methylprednisone, prednisone (PRED), prednisolone (PNL)
Conventional synthetic DMARD (csDMARD): Hydroxychloroquine (HCQ), leflunomide (LEF), methotrexate (MTX), sulfasalazine (SSZ)
Tumor necrosis factor (TNF) biologic DMARD: Adalimumab (ADA), certolizumab pegol (CZP), etanercept (ETN), golimumab (GOL), infliximab (IFX)
Non-TNF biologic DMARD: Abatacept (ABA), rituximab (RIT), sarilumab (SAR),a tocilizumab (TCZ)
Targeted synthetic DMARD (tsDMARD): Tofacitinib (TOF)a
Biosimilars: ADA-atto,a IFX-dyyb,a IFX-abda,a ETN-szzsa
Key Questions Covered by the Review
1.

Benefits of drug therapies including reducing disease activity, slowing or limiting the progression of joint damage, or inducing remission



  • Clinical tools including:
    • ACR 20/50/70
    • DAS
    • Sharp Scoreb
2.

Benefits of drug therapies including improving patient-reported symptoms, functional capacity, or quality of life



  • Clinical tools including:
    • HAQ
    • SF-36
3.

Harms of drug therapies including tolerability, patient adherence, and adverse effects



  • Harms including:
    • Overall discontinuations
    • Discontinuations attributable to AEs
    • Seriousc AEs
    • Specificd AEs
4.

Benefits and harms of drug therapies in subgroups of patients



  • Subgroups of patients defined by:
    • Age
    • Sex
    • Race or ethnicity
    • Disease activity
    • Prior treatment
    • Concomitant therapies
    • Coexisting conditions
Timing of Review
Beginning Search Date: January 2011
End Search Date: October 5, 2017
Overview of Important Studies Underway
Six trials either ongoing or completed, but findings not yet published.

a

New medications that FDA has approved since the prior report

b

Sharp-van der Heijde method for scoring radiographs

c

As defined by FDA: Life-threatening, requires hospitalization, leads to lasting disability or congenital anomaly, or jeopardizes the patient in any serious way

d

Rash, upper respiratory tract infection, nausea, pruritus, headache, diarrhea, dizziness, abdominal pain, bronchitis, leukopenia, injection site reactions

ACR 20/50/70 = American College of Rheumatology 20/50/70% improvement from baseline; AE = adverse event; csDMARD = conventional synthetic disease-modifying antirheumatic drug; DAS = Disease Activity Score; DMARD = disease-modifying antirheumatic drug; ETN = etanercept; FDA = U.S. Food and Drug Administration; HAQ = Health Assessment Questionnaire; MTX = methotrexate; RA = rheumatoid arthritis; SF-36 = Medical Outcomes Study Short Form 36 Health Survey; TCZ = tocilizumab.

From: Evidence Summary

Cover of Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update
Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 211.
Donahue KE, Gartlehner G, Schulman ER, et al.
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