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Efficacy of Monotherapy with Biologics and JAK Inhibitors for the Treatment of Rheumatoid Arthritis: A Systematic Review

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Emery P1, Pope JE2, Kruger K3, Lippe R4, DeMasi R5, Lula S6, Kola B7. Adv Ther. 2018 Aug 20. doi: 10.1007/s12325-018-0757-2. [Epub ahead of print]


Author information

1 Leeds Musculoskeletal Biomedical Research Unit, LTHT and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. p.emery@leeds.ac.uk.

2 University of Western Ontario, London, ON, Canada.

3 Faculty of Medicine of the University of Munich, Munich, Germany.

4 Pfizer, Berlin, Germany.

5 Pfizer, Collegeville, PA, USA.

6 Envision Pharma Group, London, UK.

7 Pfizer, Tadworth, Surrey, UK.


Despite recommendations suggesting that biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) should be used in combination with methotrexate in the treatment of rheumatoid arthritis (RA), up to one-third of patients with RA are treated with monotherapy. The objective of the systematic literature review reported here was to evaluate the clinical evidence regarding the efficacy of b/tsDMARDs as monotherapy in the treatment of RA. MEDLINE®, Embase®, and the Cochrane Central Trials Register (to April 11, 2017) and the American College of Rheumatology and European League Against Rheumatism conference proceedings (2010-2016) were searched for randomized controlled trials evaluating the efficacy of b/tsDMARDs as monotherapy for RA in adults. Forty-four monotherapy studies of abatacept, adalimumab, baricitinib, certolizumab pegol, etanercept, sarilumab, sirukumab, tocilizumab, and tofacitinib reported in 71 publications were identified. Tocilizumab had the most studies (14), followed by etanercept (10) and adalimumab (9). These b/tsDMARDs were consistently shown to be efficacious treatments, regardless of whether patients were intolerant of or had never used conventional synthetic (cs) DMARDs. However, better treatment outcomes were usually achieved with combination therapy, and this was observed for all b/tsDMARDs assessed by this review. Only a few studies provided a head-to-head comparison between b/tsDMARD treatments or between b/tsDMARD monotherapy and combination therapy, and as many were initial RA treatments they were not generalizable to usual care. In conclusion, evidence from randomized trials suggests that the b/tsDMARDs studied are effective as monotherapy. In general, some patient responses seem better with combination therapy and the durability of monotherapy is less than combination therapy. There is, however, a need for longer-term head-to-head trials to establish positioning of these interventions in the treatment algorithm for RA.

FUNDING: Pfizer.Plain Language Summary: Plain language summary available on the journal website.