Several studies have suggested that conventional or biological DMARDs might interfere with the pathogenic process and prevent more established forms of RA, but it remains unclear whether these drugs are equally efficacious in this setting.
Dr. Bruno Fautrel and colleagues from UPMC, Institut Pierre Louis d’epidemiologie et Sante publique, in Paris, undertook a systematic review and meta-analysis of 10 randomized controlled trials including 1,239 patients at risk of RA. They assessed the efficacy of glucocorticoids, conventional DMARDs (csDMARDS), and biological DMARDs (bDMARDs) for preventing or delaying RA development and/or blocking structural damage.
Among patients with arthralgia without arthritis, DMARDs did not significantly reduce RA occurrence, defined as satisfaction of the 1987 American College of Rheumatology classification criteria, at week 52 or beyond.
For patients with undifferentiated arthritis, however, DMARDs were associated with a significant 27% reduction in the odds of RA occurrence (from 238 events in 410 patients to 211 events in 414 patients). All drugs except TNF blockers tended to reduce the risk, the researchers report in the Annals of the Rheumatic Diseases, online June 8.
One trial demonstrated a significant effect of etanercept on clinical remission, and the meta-analysis of five studies found that early intervention with glucocorticoids and TNF blockers or abatacept increased the odds of achieving remission by 84% (from 104 remission events in 435 patients to 155 remission events in 471 patients).
DMARDs had no apparent effect on radiographic progression.
The researchers conclude that these findings “clearly demonstrate the potential benefits of very early therapeutic intervention for people who start RA and specifically its ability to prevent established RA. Our results fit perfectly with the 2017 EULAR campaign on early actions in rheumatic disorders: ‘Don’t delay, Connect today’ (https://www. eular. org/ what_ we_ do_ dont_ delay_ connect_ today.cfm).”
Dr. Fautrel did not respond to a request for comments.
- Hilliquin S, Hugues B, Mitrovic S, et al. Ability of disease-modifying antirheumatic drugs to prevent or delay rheumatoid arthritis onset: a systematic literature review and meta-analysis. Annals of Rheumatic Diseases. 2018 Jun 8. [Epub ahead of print]