Response to interleukin-6 receptor antagonists in patients with rheumatoid arthritis is independent of the number of prior used TNF inhibitors: A systematic review and metaanalysis - 11/02/21
, Teresa Oton b, Judit LLuch a, Maribel Mora-Limiñana a, Joan Miquel Nolla a, Estíbaliz Loza bBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 12 |
| Iconographies | 4 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Medium- and long-term effectiveness of TCZ and SAR therapy does not seem to be overly influenced by prior use of biologic therapy. |
• | Data from RCT suggest that the response to IL-6 pathway inhibitors seems to be similar, regardless of the number of TNFis previously tested. |
• | This differs somewhat from other biologics, since decreasing responses were observed with higher numbers of prior TNFi failures for abatacept, golimumab and rituximab. |
Abstract |
Objective |
To investigate whether early response to tocilizumab (TCZ) and sarilumab (SAR) therapy in patients with active rheumatoid arthritis (RA) is influenced by previous use of biologic agents.
Methods |
We performed a systematic literature review and a meta-analysis of original studies that analyzed the effectiveness of TCZ or SRL in subgroups of RA patients, including biologic-naïve patients versus those with inadequate response to at least one biologic DMARD (bDMARD), and patients with failure to 1 versus≥2 bDMARDs.
Results |
The study selection process finally included 17 articles corresponding to 14 studies, including 7 randomized controlled trials (RCTs). Although the existing literature that compared the response in biologic-naïve patients versus those with inadequate response to at least one bDMARD showed conflicting results, meta-analysis of 6 published studies revealed a significantly higher likelihood of remission (RR=1.3; 95% CI: 1.2–1.5) and low activity disease (RR=1.3; 95% CI: 1.2–1.4) in the biologic-naïve group at week 24. However, differences between groups were not clinically meaningful in all studies and not always maintained after 6 to 12months of treatment. In addition, data from RCT RADIATE and TARGET suggest that the response to IL-6 pathway inhibitors seems to be similar, regardless of the number of tumor necrosis factor inhibitors (TNFis) previously tested.
Conclusion |
Disease activity was more rapidly reduced in the early stages of treatment in biologic-naïve patients. However, near similar efficacy can be expected in patients who experienced a failure of at least one bDMARD (mainly TNFis) beyond the first 6 to 12months of treatment, suggesting that the response occurs independently of the number of prior TNFis.
Le texte complet de cet article est disponible en PDF.Keywords : Rheumatoid arthritis, Tocilizumab, Sarilumab, Biologic-naïve patients
Plan
Vol 88 - N° 1
Article 105112- janvier 2021 Retour au numéro
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