The Cochrane Library, known for its high-quality evidence-based reviews and other resources that physicians can use to inform their clinical decisions, launched an online journal club in October 2009—and the complex question of biologic use in rheumatoid arthritis (RA) was first the topic of discussion.
The Cochrane Journal Club is a resource for physicians and researchers who currently participate in a journal club or who would like to start one at their institution. Each monthly issue examines a recently published Cochrane review, providing summaries and analysis of the review, together with a variety of multimedia resources—including PowerPoint discussion slides with relevant charts and tables and podcasts from the authors. The Cochrane Journal Club also provides discussion points and key critical questions to facilitate journal groups’ discussion of the review at a journal club meeting. Finally, the club Web site (www.cochranejournalclub.com) has an interactive component where visitors can ask the authors questions and view questions posed by other readers.
The pilot Cochrane Journal Club highlighted “Biologics for Rheumatoid Arthritis,” the first overview of reviews to be published in the Cochrane Library. Because the paper included both information to help rheumatologists make difficult clinical decisions and innovative methodological approaches to comparing treatments indirectly, the Journal Club discussed both the clinical and methodological aspects of the review.
“Biologics for Rheumatoid Arthritis” looked at six current Cochrane reviews on different biologic disease-modifying antirheumatic drugs (DMARDs), each assessing one DMARD compared with a placebo and including at least one randomized trial. The overview of Cochrane reviews provides a summary of the benefits and harms of each DMARD and also includes indirect comparisons between the drugs. (See “Summary of the Cochrane Review.”)
Although the DMARDs reviewed did seem to improve symptoms and prevent joint deterioration, deciding which drug to prescribe a given patient still may be a challenge for rheumatologists. “Doctors are faced with a difficult dilemma when choosing biologics to prescribe to RA patients. Our Cochrane overview cannot identify the ‘best’ biologic for any individual patient,” said Jasvinder Singh, MD—lead author of the paper, a rheumatologist at the Minneapolis VA Medical Center, and associate professor of medicine at the University of Minnesota in Minneapolis—in the Journal Club podcast. “That choice needs to use other knowledge as well. Some of that knowledge is in the individual Cochrane reviews … and some of it will need to come through local information and discussion with the patients. For example, how much experience is there with a particular biologic in the clinical team and does the patient have preferences about the different ways in which the drugs need to be taken?”
Summary of the Cochrane Review
Singh JA, Christensen R, Wells GA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007848. DOI: 10.1002/14651858. CD007848.pub2. Copyright The Cochrane Collaboration, reproduced with permission.
