| Abstract | OBJECTIVE: Treatments for psoriatic arthritis (PsA) range from high-cost agents such as tumour necrosis factor (TNF) inhibitors evaluated in large randomised control trials (RCTs) and low-cost disease-modifying anti-rheumatic drugs (DMARDs) studied in less detail. We compared their efficacy and toxicity in a systematic review. METHODS: We searched Medline, PubMed and EmBase (1966-2006) for RCTs in PsA. We included RCTs that were randomised, placebo-controlled, in English, involved current treatments and only enrolled PsA patients. Efficacy was assessed by the numbers of patients withdrawn for lack of effect; toxicity by withdrawals for adverse events. RCTs were compared using risk ratios (RR) with 95% confidence intervals (CI). RESULTS: We identified 32 potentially relevant RCTs; 14 were excluded because they involved unused agents, were unblinded, were not placebo-controlled and enrolled patients with other diseases. 18 studies were included in the meta-analysis assessing DMARD monotherapy (11), DMARD combinations (one), TNF inhibitors (five) and alefacept (one). Treatment was more effective than placebo (RR = 0.35; 95% CI 0.25, 0.49) but caused more toxicity (RR = 2.33; 95% CI 1.61, 3.37). There was evidence that gold, sulfasalazine, leflunomide and TNF inhibitors were effective; gold and TNF inhibitors showed the largest effect sizes; TNF inhibitors had the best efficacy/toxicity ratio (number needed to harm/number needed to treat = 0.25); tolerability was least with gold and leflunomide. CONCLUSIONS: Efficacy/toxicity ratios were highest with TNF inhibitors followed by leflunomide, gold and sulfasalazine. Gold, though effective, has excessive toxicity and sulfasalazine, though of low toxicity, was also relatively ineffective. |
| Authors | V Ravindran, D L Scott, E H Choy
(Affiliation: Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of Rheumatology, King's College London, London, UK.)
|
| Journal | Annals of the rheumatic diseases
(Ann Rheum Dis)
Vol. 67
Issue 6
Pg. 855-9
(Jun 2008)
ISSN: 1468-2060 England |
| PMID | 17827183
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)
|
| Chemical References |
- Antirheumatic Agents
- Biological Products
- Isoxazoles
- Recombinant Fusion Proteins
- Tumor Necrosis Factor-alpha
- alefacept
- Sulfasalazine
- leflunomide
|
| Topics |
- Antirheumatic Agents
(adverse effects, therapeutic use)
- Arthritis, Psoriatic
(drug therapy)
- Biological Products
(adverse effects, therapeutic use)
- Humans
- Isoxazoles
(adverse effects, therapeutic use)
- Randomized Controlled Trials as Topic
- Recombinant Fusion Proteins
(adverse effects, therapeutic use)
- Risk Assessment
(methods)
- Sulfasalazine
(adverse effects, therapeutic use)
- Treatment Outcome
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
|
