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Efficacy of initial methotrexate monotherapy versus combination therapy with a biological agent in early rheumatoid arthritis: A meta-analysis of clinical and radiographic remission
Annals of Rheumatic Diseases, 05/07/2010
Clinical Article
Kuriya B et al. – The efficacy of combination therapy with a biological agent is superior to methotrexate monotherapy for remission. Combination therapy has a greater initial effect on clinical remission than radiographic non-progression.
Methods- Systematic search was performed for randomised controlled trials of ERA using predefined criteria
- Random effects model was used to pool the RR for clinical and radiographic remission at 52–56 weeks of follow-up
- 7 trials of combination therapy with infliximab, adalimumab, etanercept or abatacept were included
- Majority of studies defined clinical remission as a 28-joint disease activity score (DAS28) of 2.6 or less
- Radiographic non-progression was primarily defined as a modified total Sharp score change of less than 0.5 units
- All trials demonstrated risk estimates in favour of combination therapy: the pooled RR for achieving clinical remission was 1.74 (95% CI 1.54 to 1.98) and for radiographic non-progression was 1.30 (95% CI 1.01 to 1.68)
- Significant heterogeneity among studies for the latter outcome was detected (p< 0.001)