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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Arthritis+Res+Ther
2016 ; 18
(1
): 211
Nephropedia Template TP
gab.com Text
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English Wikipedia
Tocilizumab as monotherapy or combination therapy for treating active rheumatoid
arthritis: a meta-analysis of efficacy and safety reported in randomized
controlled trials
#MMPMID27658491
Arthritis Res Ther
2016[Sep]; 18
(1
): 211
PMID27658491
show ga
BACKGROUND: Previous studies in patients with rheumatoid arthritis (RA) have
shown that switching to tocilizumab (TCZ) monotherapy (TCZ(MONO)) or combination
therapy (TCZ(COMBI)) with conventional synthetic disease-modifying anti-rheumatic
drugs (csDMARDs) is efficacious in reducing disease activity in patients with
inadequate response to csDMARDs. However, hitherto there is no consensus on
whether TCZ(MONO) is as effective as TCZ(COMBI). The objective of this study was
therefore to evaluate the efficacy and safety of TCZ(MONO) versus add-on
TCZ(COMBI) and both TCZ therapies versus continuing the current csDMARD therapy,
by performing a systematic review and meta-analyses. METHOD: The MEDLINE, EMBASE
and CENTRAL databases were searched until February 2016 for relevant randomized
controlled trials (RCTs). We performed meta-analyses of Disease Activity Score in
28 joints (DAS28?2.6), American College of Rheumatology (ACR) 20/50/70
responses, adverse events (AEs) and serious AEs (SAEs) to compare the three
different strategies, whereas a random-effect model was used for pooling relative
risks (RR) and 95 % confidence intervals (CI). In addition, sensitivity analyses
were performed for evaluating differences in study duration. RESULTS: In total,
13 RCTs were included in the meta-analysis, involving 6679 patients. When
comparing both TCZ strategies, a marginally greater proportion of patients
achieving DAS28?2.6 (RR 1.21; 95 % CI 1.09, 1.36) and ACR50 response (RR 1.14;
95 % CI 1.03, 1.26) was found in favor of the TCZ(COMBI) strategy. However, the
risk of SAEs was also significantly higher using this strategy (RR 1.40; 95 % CI
1.03, 1.92, p?=?0.03). Pooled effect estimates showed statistical superiority of
switching to either TCZ strategy compared to continuing csDMARD therapy.
CONCLUSIONS: In the management of active RA, almost similar efficacy can be
expected in patients unable to tolerate csDMARDs, who switch to TCZ(MONO)
compared to inadequate responders switching to add-on TCZ(COMBI). Although
TCZ(COMBI) is marginally superior to TCZ(MONO) in achieving DAS28?2.6 and ACR50
response, this is at the cost of an increased risk of SAEs.