ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 439

Progression of Radiographic Joint Destruction in Patients with Rheumatoid Arthritis Treated with a Biologic Agent in Combination with Methotrexate Versus a Biologic Alone: A Systematic Review and Meta-Analysis of Randomized Trials

Tanja Schjødt Jørgensen1, Simon Tarp1, Daniel E. Furst2, Anna Døssing1, Peter C. Taylor3, Henning Bliddal1 and Robin Christensen1, 1Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, 2Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, 3Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, Kennedy Institute of Rheumatology, University of Oxford,, Oxford, United Kingdom

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , , ,

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose :
One of the frequently claimed advantages of biologic agents
is their potential to arrest radiographic progression. The ability of disease-modifying
antirheumatic drugs (DMARDs;
typically methotrexate, MTX) is less well defined because the effect of DMARDs when
added to biologic agents (bDMARDs) on radiographic progression has only
sporadically been investigated in randomized trials. The objective of the present
study was to review the evidence on radiographic joint destruction in patients
with RA between therapies combining MTX with a bDMARD and bDMARD in monotherapy.

Methods: A systematic review and meta-analysis of
randomized trials was performed to identify trials relating treatment of RA
with MTX in combination with bDMARD, compared to a bDMARD in monotherapy. According
to the protocol a major outcome was radiographic joint progression assessed by
total sharp score (TSS). A random-effects model was applied for meta-analysis
with standardized mean difference and 95% confidence intervals (SMD, 95%CI) and
inconsistency (I2, %) estimated using Review Manager. The protocol
is available from PROSPERO: CRD42014014633.

Results: From the 14 trials that were eligible
for inclusion (1), only 7 trials assessed radiographic joint progression (Trial
duration ranging from 24 to 104 weeks). The use of the Intention to treat
population was frequently ‘unclear/inadequate’, reducing our confidence in the
estimates. The overall analysis of changes in radiographic joint progression showed
an SMD of 0.16 [0.09 to 0.23, P<.0001] – apparently with no heterogeneity (P=
.58) and inconsistency (0%). Using an SD of 20 TSS unit, this effect size
corresponds to a difference between the groups of 3.2 TSS units in favor of
concomitant use of MTX when treating with a biologic (after approximately 52
weeks; see Figure). We found no reason to suspect that the added value of MTX
varied with the choice of bDMARD (Test for subgroup differences P= .66).

Conclusion: This
study provides moderate quality evidence that combining the prescribed bDMARD
with concomitant use of MTX is significantly more efficacious in preventing
structural joint destruction compared to patients taking biologics as
monotherapy.

 

Reference:

1) Jørgensen TS, et al. Ann
Rheum Dis2015;74(Suppl2): 239

 

Acknowledgement: This
study was supported by unrestricted grants from The Oak foundation, and AbbVie
(Denmark).

 

Figure

 

 

 

 

 

 

 

Disclosure: T. S. Jørgensen, AbbVie and Roche, 2; S. Tarp, AbbVie and Roche, 2; D. E. Furst, Gilead, 2,GlaxoSmithKline, 2,NIH, 2,Novartis Pharmaceutical Corporation, 2,Pfizer Inc, 2,Roche Pharmaceuticals, 2,Genentech and Biogen IDEC Inc., 2,UCB, 2,Abbvie, 5,Actelion Pharmaceuticals US, 5,Amgen, 5,Bristol-Myers Squibb, 5,Cytori, 5,Janssen Pharmaceutica Product, L.P., 5,Gilead, 5,GlaxoSmithKline, 5,NIH, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,Genentech and Biogen IDEC Inc., 5,UCB, 5,Abbvie, 8,Actelion Pharmaceuticals US, 8,Bristol-Myers Squibb, 2,Amgen, 2,Actelion Pharmaceuticals US, 2,Abbvie, 2,UCB, 8; A. Døssing, None; P. C. Taylor, None; H. Bliddal, AbbVie and Roche, 2; R. Christensen, AbbVie, MSD, and Roche, 2.

To cite this abstract in AMA style:

Jørgensen TS, Tarp S, Furst DE, Døssing A, Taylor PC, Bliddal H, Christensen R. Progression of Radiographic Joint Destruction in Patients with Rheumatoid Arthritis Treated with a Biologic Agent in Combination with Methotrexate Versus a Biologic Alone: A Systematic Review and Meta-Analysis of Randomized Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/progression-of-radiographic-joint-destruction-in-patients-with-rheumatoid-arthritis-treated-with-a-biologic-agent-in-combination-with-methotrexate-versus-a-biologic-alone-a-systematic-review-and-meta/. Accessed .

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