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Review
. 2016 Jan;75(1):16-22.
doi: 10.1136/annrheumdis-2015-207526. Epub 2015 May 19.

Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update

Michaela A Stoffer  1 , Monika M Schoels  2 , Josef S Smolen  3 , Daniel Aletaha  4 , Ferdinand C Breedveld  5 , Gerd Burmester  6 , Vivian Bykerk  7 , Maxime Dougados  8 , Paul Emery  9 , Boulos Haraoui  10 , Juan Gomez-Reino  11 , Tore K Kvien  12 , Peter Nash  13 , Victoria Navarro-Compán  14 , Marieke Scholte-Voshaar  15 , Ronald van Vollenhoven  16 , Désirée van der Heijde  5 , Tanja A Stamm  4
Affiliations
Review

Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update

Michaela A Stoffer et al. Ann Rheum Dis. 2016 Jan.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Ann Rheum Dis. 2016 May;75(5):946. doi: 10.1136/annrheumdis-2015-207526corr1. Ann Rheum Dis. 2016. PMID: 27060159 Free PMC article. No abstract available.

Abstract

Objective: A systematic literature review (SLR; 2009-2014) to compare a target-oriented approach with routine management in the treatment of rheumatoid arthritis (RA) to allow an update of the treat-to-target recommendations.

Methods: Two SLRs focused on clinical trials employing a treatment approach targeting a specific clinical outcome were performed. In addition to testing clinical, functional and/or structural changes as endpoints, comorbidities, cardiovascular risk, work productivity and education as well as patient self-assessment were investigated. The searches covered MEDLINE, EMBASE, Cochrane databases and Clinicaltrial.gov for the period between 2009 and 2012 and separately for the period of 2012 to May of 2014.

Results: Of 8442 citations retrieved in the two SLRs, 176 articles underwent full-text review. According to predefined inclusion/exclusion criteria, six articles were included of which five showed superiority of a targeted treatment approach aiming at least at low-disease activity versus routine care; in addition, publications providing supportive evidence were also incorporated that aside from expanding the evidence provided by the above six publications allowed concluding that a target-oriented approach leads to less comorbidities and cardiovascular risk and better work productivity than conventional care.

Conclusions: The current study expands the evidence that targeting low-disease activity or remission in the management of RA conveys better outcomes than routine care.

Keywords: Disease Activity; Rheumatoid Arthritis; Treatment.

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Figures

Figure 1
Figure 1
Flow chart of the systematic literature search. Diagrammed are the results of the initial and second search (2012 and 2014, respectively) and the selection process of abstract screening, full-text review and inclusion according to expert opinion.
Figure 2
Figure 2
Rick of bias summary figure. +Low risk of bias, −High risk of bias, ?Unclear risk of bias, n.a. Not applicable. *In the study of Pope et al physicians were randomised. **Vermeer et al was comparing real life data from cohorts.
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