Evidence map›Paper›PMID 33253497›Full record

ArticleArthritis care & research2022

Efficacy of Tocilizumab Monotherapy Versus Tocilizumab and Methotrexate Combination Therapy in the Prevention of Radiographic Progression in Rheumatoid Arthritis: An Analysis Using Individual Patient Data From Multiple Clinical Trials.

Maxime M A Verhoeven, Janneke Tekstra, Johannes W G Jacobs, Johannes W J Bijlsma, Jacob M van Laar, Attila Pethö-Schramm, Michelle E A Borm, Floris P J Lafeber, Paco M J Welsing

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PubMed Full text at PMC Publisher
In one paragraph

Article in Arthritis care & research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.5field-weighted citation impact, top 31% 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

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
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  4. Review
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

9 authors at 3 institutions in 2 countries.

Maxime M A VerhoevenUniversity Medical Center Utrecht and Utrecht University, The Netherlands.ORCID 0000-0002-5602-3856
Janneke TekstraUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Johannes W G JacobsUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Johannes W J BijlsmaUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Jacob M van LaarUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Attila Pethö-SchrammF. Hoffmann-La Roche, Basel, Switzerland.
Michelle E A BormRoche Nederland BV, Woerden, The Netherlands.
Floris P J LafeberUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Paco M J WelsingUniversity Medical Center Utrecht and Utrecht University, The Netherlands.
Utrecht University · NLRoche (Netherlands) · NLRoche (Switzerland) · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the effects of preventing radiographic progression (in its 3 components) of tocilizumab (TCZ) monotherapy with those of TCZ and methotrexate (MTX) in combination therapy (TCZ + MTX), and to evaluate possible effect modifiers in this model.

methodsRandomized trials that compared TCZ monotherapy to TCZ + MTX combination therapy for differences in radiographic progression were analyzed on an individual patient data level using mixed-effects models, and data were collected from 820 subjects with either early rheumatoid arthritis (RA) or established RA. Outcomes were classified as the absence of radiographic progression after 2 years (i.e., preventing radiographic progression) as measured by total Sharp/van der Heijde score (SHS), erosion score, and joint space narrowing (JSN) score. Effect modification by baseline joint damage, disease duration, and Disease Activity Score in 28 joints (DAS28) was studied.

resultsOverall, TCZ + MTX combination therapy was more effective in preventing radiographic progression compared to TCZ monotherapy, which was measured by total SHS score. However, in patients with early RA who had more joint damage compared to those with less joint damage at baseline (relative risk [RR] 1.02 versus RR 0.91, respectively) or in patients with a lower DAS28 score compared to those with a higher DAS28 score (RR 1.04 versus RR 0.92, respectively) at baseline, this advantage disappeared. In patients with established RA, the advantage of TCZ + MTX versus TCZ alone in the prevention of radiographic progression disappeared with a longer disease duration at baseline (RR 1.04 versus 0.83). Results of erosion scores as an outcome were in line with these findings, though findings for JSN scores were less clear.

conclusionCombination therapy with TCZ + MTX is more effective in preventing radiographic progression compared to TCZ monotherapy, but the effectiveness of TCZ monotherapy may approximate the effectiveness of TCZ + MTX in patients with early RA who have more joint damage and/or a lower DAS28 at baseline and in patients with established RA who have longer disease duration.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidAntibodies, Monoclonal, HumanizedDisease ProgressionDrug Therapy, CombinationHumansMethotrexateRandomized Controlled Trials as TopicTreatment OutcomeAntibodies, Monoclonal, HumanizedAntirheumatic AgentsMethotrexatetocilizumab

Identifiers

PMID33253497
PMCPMC9313860
OpenAlexW3108382749

What OpenQuestion holds

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LicenceCC BY-NC-ND
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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.