Table 3.
Summary of Findings About Benefits and Harms of Treatments for Early Rheumatoid Arthritis with Strength of Evidence Grades
| Key comparisons | Efficacy Strength of evidence |
Harms Strength of evidence |
|||
|---|---|---|---|---|---|
| Treatment types | Specific treatments | Rating | Explanation | Rating | Explanation |
| TNF biologics vs. MTX | ADA + MTX vs. ADA vs. MTX | Moderate | ACR response and remission significantly higher, radiographic progression less, and functional capacity significantly improved with ADA + MTX vs. ADA or with ADA vs. MTX.17 | Moderate | No significant differences in discontinuation because of adverse events or serious adverse events for ADA + MTX vs. ADA or for ADA vs. MTX17 |
| Non-TNF biologics vs. MTX | ABA + MTX vs. ABA vs. MTX | Low | No significant differences in ACR response50, 53 or remission50 for ABA + MTX vs. ABA or for ABA vs. MTX | Low | No significant differences in discontinuation because of adverse events or serious adverse events for ABA + MTX vs. ABA or for ABA vs. MTX50 |
| TCZ + MTX vs. TCZ or TCZ vs. MTX | Low | Remission significantly higher for TCZ + MTX vs. TCZ and TCZ vs. MTX51, 52 | Moderate | No significant differences in discontinuation because of adverse effects or serious adverse events for TCZ + MTX vs. TCZ or for TCZ vs. MTX51, 52 | |
| Insufficient | Functional capacity and disease activity51, 52 | ||||
| ADA + MTX vs. MTX | Moderate | Functional capacity significantly improved for ADA + MTX vs. MTX17, 22, 24, 26, 33, 62 | Low | No significant differences in discontinuation because of adverse events for ADA + MTX vs. MTX17, 22, 24, 26, 33, 62 | |
| Low | ACR response significantly higher with ADA + MTX vs. MTX17, 22, 24, 26, 33, 62 | Low | No significant differences in serious adverse events for ADA + MTX vs. MTX17, 22, 24, 26, 33, 62 | ||
| Low | Remission significantly higher with ADA + MTX vs. MTX17, 22, 24, 26, 33, 62 | ||||
| Low | Radiographic progression less with ADA + MTX vs. MTX17 | ||||
| TNF biologic + MTX vs. MTX monotherapy | CZP + MTX vs. MTX | Low | ACR response36, 63 significantly higher and radiographic progression20 less for CZP + MTX vs. MTX | Low | No significant differences in discontinuation because of adverse effects or serious adverse events20 |
| Low | Remission significantly higher and functional capacity improved for CZP + MTX vs. MTX20 | ||||
| ETN + MTX or ETN vs. MTX | Moderate | ACR response significantly higher and radiographic progression less for ETN + MTX and ETN vs. MTX37, 38 | Low | No significant differences in discontinuation because of adverse effects or serious adverse events37, 38 | |
| Low | Remission rates significantly higher for ETN + MTX and ETN vs. MTX37, 38 | ||||
| Low | Functional capacity mixed for ETN + MTX and ETN vs. MTX37, 38 | ||||
| IFX + MTX vs. MTX | Low | Remission rates45, 46 significantly higher and functional capacity45, 46 greater for IFX + MTX vs. MTX | Low | No significant differences in discontinuation because of adverse effects or serious adverse events45 | |
| Insufficient | Disease activity45–47 and radiographic progression45, 46 for IFX + MTX vs. MTX | ||||
| TNF biologic vs. csDMARD combination therapy (e.g., triple therapy) | IFX + MTX vs. MTX + SSZ + HCQ | Low | ACR response significantly higher for IFX + MTX vs. MTX + SSZ+ HCQ64 | Low | No significant differences in discontinuation because of adverse effects or serious adverse events.64 |
| IFX + MTX + SSZ + HCQ+ PRED vs. MTX + SSZ + HCQ + PRED | Low | No significant differences in ACR response, radiographic progression, or remission for IFX + MTX + SSZ + HCQ + PRED vs. MTX + SSZ + HCQ + PRED65 | Low | No significant differences in discontinuation because of adverse effects or serious adverse events65 | |
| Low | No significant differences in functional capacity for IFX + MTX + SSZ + HCQ + PRED vs. MTX + SSZ + HCQ + PRED65 | ||||
| Non-TNF biologic vs. MTX monotherapy | ABA + MTX vs. MTX | Moderate | Disease activity significantly improved and remission rates higher for ABA + MTX vs. MTX50, 53 | Low | No significant differences in discontinuation because of adverse effects or serious adverse events53 |
| Low | Radiographic progression significantly less for ABA + MTX vs. MTX53 | ||||
| Low | Functional capacity mixed for ABA + MTX vs. MTX50, 53 | ||||
| RIT + MTX vs. MTX | Moderate | Disease activity significantly improved and radiographic progression less for RIT + MTX vs. MTX57 | Moderate | No significant differences in discontinuation because of adverse effects or serious adverse events57 | |
| Moderate | Remission rates significantly higher for RIT + MTX vs. MTX57 | ||||
| Moderate | Functional capacity significantly improved for RIT + MTX vs. MTX57 | ||||
| TCZ + MTX vs. MTX | Moderate | Radiographic progression less for TCZ + MTX vs. MTX51, 52 | Moderate | No significant differences in discontinuation because of adverse effects or serious adverse events51, 52 | |
| Low | Remission significantly higher for TCZ + MTX vs. MTX51, 52 | ||||
| Insufficient | Disease activity and functional capacity for TCZ + MTX vs. MTX51, 52 | ||||
| TNF vs. non-TNF biologics | RIT vs. ADA or ETN | Low | Functional capacity significantly improved for RIT vs. ADA or ETN66 | Insufficient | Discontinuation because of adverse effects or serious adverse events66 |
| Insufficient | Disease activity or remission for RIT vs. ADA or ETN66 | ||||
ABA abatacept, ACR American College of Rheumatology, ADA adalimumab, csDMARD conventional synthetic DMARD, CZP certolizumab pegol, DAS Disease Activity Score, DMARD disease-modifying antirheumatic drug, ETN etanercept, HCQ hydroxychloroquine, IFX infliximab, MTX methotrexate, PRED prednisone, RIT rituximab, TCZ tocilizumab, TNF tumor necrosis factor, tsDMARD targeted synthetic DMARD, vs. versus