Efficacy of Monotherapy with Biologics and JAK inhibitors for the Treatment of Rheumatoid Arthritis: A Systematic Review
The b/tsDMARDs evaluated in this systematic literature review (SLR) were shown to be efficacious as monotherapies, although combination therapies usually achieved better treatment outcomes.
Current treatment guidelines recommend combining b/tsDMARDs with MTX in the treatment of RA; however, up to a third of patients are treated with monotherapy. While previous SLRs1–3 have compared the efficacy of b/tsDMARD mono- versus MTX combination therapy they covered a limited number of randomised controlled trials (RCTs) and did not include newer treatments. The relative benefit of one drug over another has not been fully elucidated.
This SLR reports the clinical evidence regarding the efficacy of b/tsDMARDs as monotherapies in the treatment of RA. The b/tsDMARDs evaluated were abatacept (ABA), adalimumab (ADA), certolizumab pegol (CZP), etanercept (ETN), sirukumab (SRK), sarilumab (SRL), sulfasalazine (SSZ), tocilizumab (TCZ), and tofacitinib (TOFA). Databases were searched for RCTs meeting the eligibility criteria for efficacy outcomes, study design, treatment data, patient demographics and clinical characteristics. A variety of treatment regimens were examined including b/tsDMARDs monotherapy versus: combination therapy, another drug (MTX or biologic) or placebo; ACR20/50/70 responses for each were evaluated.
In patients who were naïve or intolerant to csDMARDs, b/tsDMARDs, monotherapy was generally more efficacious than csDMARD monotherapy, with patients achieving higher ACR response rates. However, b/tsDMARD monotherapy was inferior to combination treatment of csDMARDs.
The authors concluded that several of the b/tsDMARDs evaluated in this study are efficacious as monotherapies. Further studies are needed to show which treatments will be effective as a monotherapy when used in early RA treatment.
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1. Tarp S, et al. Semin Arthritis Rheum 2017;46:699–708.