Authors' objectives:

In February 2009, the Norwegian Rheumatism Association commissioned the Norwegian Center for Health Services to summarise the available research on the effects and safety of early interventions in rheumatoid diseases, and to prepare an economic evaluation of such interventions. In understanding with the commissioner, we have chosen to limit the current report to a systematic review of the efficacy and safety of biologics compared with DMARDs in people with RA for less than three years.

Authors' recommendations: This systematic review has shown that biologics combined with DMARDs may increase remission by 78% compared to treatment with DMARDs alone. In absolute figures, 45% and 25% achieved remission with the use of biologics combined with DMARDs and DMARDs alone, respectively. It remains unclear whether biologics use is associated with an increased risk of adverse effects. Compared with DMARDs, the use of biologics can be expected to limit radiographic progression during the first year of therapy, but the clinical significance of this finding implies that the difference in the effect persists over the years. All other outcomes were in favour of biologics, but methodological weaknesses imply a degree of uncertainty. Future research should focus on very early RA, and perhaps only include people who are recently diagnosed with the new ACR-/EULAR-criteria. Moreover, an important future research task is to identify subgroups of early RA patients who would obtain remission with biologics as first line treatment. Head-to-head studies that examine the relative effects of the various biological agents are also an imminent research need.

Project Status: Completed

URL for project: http://www.kunnskapssenteret.no/Publikasjoner/9235.cms?language=english&threepage=1

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: Norwegian Knowledge Centre for the Health Services (NOKC)