Efficacy and Safety of Combined Therapy With Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Systematic Literature Review

OBJECTIVE1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODSA systematic literature review (SLR) was performed with a sensit...

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Published in:Reumatología clinica (Barcelona) 2020-09, Vol.16 (5 Pt 1), p.324-332
Main Authors: Calvo Alén, Jaime, Pérez, Trinidad, Romero Yuste, Susana, Ferraz-Amaro, Iván, Alegre Sancho, Juan José, Pinto Tasende, José Antonio, Maceiras Pan, Francisco, Quevedo, Juan Carlos, Hernández-Hernández, M Vanesa, Hidalgo Calleja, Cristina, San Martín Álvarez, Alejandro, Sánchez, María Isabel Tevar, Sanmartí, Raimon
Format: Article
Language:eng ; spa
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Summary:OBJECTIVE1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODSA systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTSUltimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONSThese recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.
ISSN:2173-5743
DOI:10.1016/j.reuma.2018.07.016