Evidence map›Paper›PMID 30376836›Full record

SynthesisBMC musculoskeletal disorders2018

Intensive therapy and remissions in rheumatoid arthritis: a systematic review.

Catherine D Hughes, David L Scott, Fowzia Ibrahim, TITRATE Programme Investigators

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC musculoskeletal disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 3 pooled it
5.1field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Secondary Mania induced by TNF-α inhibitors: A systematic review.Psychiatry and clinical neurosciences · 2022
    Pooled it
  4. Trial
  5. Article
  6. Observational
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Review
  15. Review
  16. Review
  17. [Treat to target-participation of the patient].Zeitschrift fur Rheumatologie · 2019
    Review
  18. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Catherine D HughesDepartment of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK. chughes20@nhs.net.ORCID http://orcid.org/0000-0002-2553-7555
David L ScottDepartment of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
Fowzia IbrahimDepartment of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
TITRATE Programme Investigators
King's College London · GB

Funding

Department of Health RP-PG-0610-10066Medical Research Council MC_UU_00002/2Programme Grants for Applied Research RP-PG-0610-10066
6 · The paper itself

Abstract

backgroundWe systematically reviewed the effectiveness of intensive treatment strategies in achieving remission in patients with both early and established Rheumatoid Arthritis (RA).

methodsA systematic literature review and meta-analysis evaluated trials and comparative studies reporting remission in RA patients treated intensively with disease modifying anti-rheumatic drugs (DMARDs), biologics and Janus Kinase (JAK) inhibitors. Analysis used RevMan 5.3 to report relative risks (RR) in random effects models with 95% confidence intervals (CI).

resultsWe identified 928 publications: 53 studies were included (48 superiority studies; 6 head-to-head trials). In the superiority studies 3013/11259 patients achieved remission with intensive treatment compared with 1211/8493 of controls. Analysis of the 53 comparisons showed a significant benefit for intensive treatment (RR 2.23; 95% CI 1.90, 2.61). Intensive treatment increased remissions in both early RA (23 comparisons; RR 1.56; 1.38, 1.76) and established RA (29 comparisons RR 4.21, 2.92, 6.07). All intensive strategies (combination DMARDs, biologics, JAK inhibitors) increased remissions. In the 6 head-to-head trials 317/787 patients achieved remission with biologics compared with 229/671 of patients receiving combination DMARD therapies and there was no difference between treatment strategies (RR 1.06; 0.93. 1.21). There were differences in the frequency of remissions between early and established RA. In early RA the frequency of remissions with active treatment was 49% compared with 34% in controls. In established RA the frequency of remissions with active treatment was 19% compared with 6% in controls.

conclusionsIntensive treatment with combination DMARDs, biologics or JAK inhibitors increases the frequency of remission compared to control non-intensive strategies. The benefits are seen in both early and established RA.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidBiological ProductsDrug Therapy, CombinationHumansJanus Kinase InhibitorsRandomized Controlled Trials as TopicRemission InductionTreatment OutcomeAntirheumatic AgentsBiological ProductsJanus Kinase InhibitorsEarly or established rheumatoid arthritisOutcomeRemissionTreatment response

Identifiers

PMID30376836
PMCPMC6208111
OpenAlexW2898677952

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.