Evidence map›Paper›PMID 34003970›Full record

SynthesisRheumatology (Oxford, England)2021

A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis.

Maryam A Adas, Victoria B Allen, Mark Yates, Katie Bechman, Benjamin D Clarke, Mark D Russell, Andrew I Rutherford, Andrew P Cope, Sam Norton, James B Galloway

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Rheumatology (Oxford, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 27% 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, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Review
  4. 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

10 authors at 1 institution in 1 country.

Maryam A AdasCentre for Rheumatic Diseases, King's College London, London, UK.ORCID 0000-0002-5560-6603
Victoria B AllenCentre for Rheumatic Diseases, King's College London, London, UK.
Mark YatesCentre for Rheumatic Diseases, King's College London, London, UK.ORCID 0000-0001-5449-5211
Katie BechmanCentre for Rheumatic Diseases, King's College London, London, UK.
Benjamin D ClarkeCentre for Rheumatic Diseases, King's College London, London, UK.
Mark D RussellCentre for Rheumatic Diseases, King's College London, London, UK.ORCID 0000-0001-8171-7772
Andrew I RutherfordCentre for Rheumatic Diseases, King's College London, London, UK.ORCID 0000-0002-5183-7965
Andrew P CopeCentre for Rheumatic Diseases, King's College London, London, UK.
Sam NortonCentre for Rheumatic Diseases, King's College London, London, UK.ORCID 0000-0003-1714-9963
James B GallowayCentre for Rheumatic Diseases, King's College London, London, UK.
King's College London · GB

Funding

Medical Research Council MR/R001332/1
6 · The paper itself

Abstract

objectivesTo evaluate the safety of treatment strategies in patients with early RA.

methodsSystematic searches of MEDLINE, EMBASE and PubMed were conducted up to September 2020. Double-blind randomized controlled trials (RCTs) of licensed treatments conducted on completely naïve or MTX-naïve RA patients were included. Long-term extension studies, post-hoc and pooled analyses and RCTs with no comparator arm were excluded. Serious adverse events, serious infections and non-serious adverse events were extracted from all RCTs, and event rates in intervention and comparator arms were compared using meta-analysis and network meta-analysis (NMA).

resultsFrom an initial search of 3423 studies, 20 were included, involving 9202 patients. From the meta-analysis, the pooled incidence rates per 1000 patient-years for serious adverse events were 69.8 (95% CI: 64.9, 74.8), serious infections 18.9 (95% CI: 16.2, 21.6) and non-serious adverse events 1048.2 (95% CI: 1027.5, 1068.9). NMA showed that serious adverse event rates were higher with biologic monotherapy than with MTX monotherapy, rate ratio 1.39 (95% CI: 1.12, 1.73). Biologic monotherapy rates were higher than those for MTX and steroid therapy, rate ratio 3.22 (95% CI: 1.47, 7.07). Biologic monotherapy had a higher adverse event rate than biologic combination therapy, rate ratio 1.26 (95% CI: 1.02, 1.54). NMA showed no significant difference between strategies with respect to serious infections and non-serious adverse events rates.

conclusionThe study revealed the different risk profiles for various early RA treatment strategies. Observed differences were overall small, and in contrast to the findings of established RA studies, steroid-based regimens did not emerge as more harmful.

Indexed as

AdultAntirheumatic AgentsArthritis, RheumatoidBiological ProductsDouble-Blind MethodDrug-Related Side Effects and Adverse ReactionsFemaleHumansMaleMethotrexateMiddle AgedRandomized Controlled Trials as TopicSecondary PreventionSteroidsTreatment OutcomeAntirheumatic AgentsBiological ProductsMethotrexateSteroidsadverse eventsDMARD naïveearly rheumatoid arthritisnetwork meta-analysistreatment strategies

Identifiers

PMID34003970
PMCPMC8487311
OpenAlexW3162784280

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.