Structured Abstract

Contents

• Purpose and Key Messages
• Preface
• Acknowledgments
• Evidence Summary
  • Introduction and Methods
  • Results and Key Findings
  • Discussion and Findings in Context
  • Key Limitations and Research Gaps
• Introduction
  • Condition
  • Scope and Key Questions
  • Analytic Framework
  • Organization of This Report
• Methods
  • Criteria for Inclusion/Exclusion of Studies in the Review
  • Searching for the Evidence: Literature Search Strategies for Identification of Relevant Studies To Answer the Key Questions
  • Literature Review, Data Abstraction, and Data Management
  • Assessment of Methodological Risk of Bias of Individual Studies
  • Data Synthesis
  • Grading the Strength of Evidence for Major Comparisons and Outcomes
  • Assessing Applicability
  • Peer Review and Public Commentary
• Results
  • Organization of the Results
  • Search Results
  • KQ 1. Comparative Benefits of Drug Therapies for Patients With Early RA in Relation to Disease Activity, Progression of Radiographic Joint Damage, or Remission
  • KQ 2. Comparative Benefits of Drug Therapies for Patients With Early RA in Relation to Patient-Reported Symptoms, Functional Capacity, or Quality of Life
  • KQ 3. Comparative Harms of Drug Therapies for Patients With Early RA in Relation to Harms, Tolerability, Patient Adherence, or Adverse Effects
  • KQ 4. Comparative Benefits and Harms in Subgroups of Patients
• Discussion
  • Overview of Key Findings
  • Findings in Relationship to What Is Already Known
  • Applicability
  • Contextual Questions
  • Limitations
  • Research Needs
  • Conclusions
• Abbreviations and Acronyms
• Appendix A. Search Strings
• Appendix B. Excluded Articles
• Appendix C. Detailed Evidence Table
• Appendix D. Risk of Bias Ratings and Rationales for Included Studies
• Appendix E. Strength of Evidence for Key Questions 1–4 Outcomes
• Appendix F. Eligible Clinical and Self-Reported Scales and Instruments Commonly Used in Eligible Studies of Drug Therapy for Rheumatoid Arthritis
• Appendix G. Tests of Consistency for Main Network Meta-Analyses
• Appendix H. Supplementary Primary Network Meta-Analyses
• Appendix I. Sensitivity Analyses for Network Meta-Analyses
• Appendix J. Expert Guidance and Review
• Appendix K. PCORI Methodology Standards Checklist: SER Update
• Report References

Suggested citation:

Donahue KE, Gartlehner G, Schulman ER, Jonas B, Coker-Schwimmer E, Patel SV, Weber RP, Lohr KN, Bann C, Viswanathan M. Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update. Comparative Effectiveness Review No. 211. (Prepared by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center under Contract No. 290-2015-00011-I for AHRQ and PCORI.) AHRQ Publication No. 18-EHC015-EF. PCORI Publication No. 2018-SR-02. Rockville, MD: Agency for Healthcare Research and Quality; July 2018. Posted final reports are located on the Effective Healthcare Program search page. https://doi.org/10.23970/AHRQEPCCER211.

This report is based on research conducted by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00011-I). The Patient-Centered Outcomes Research Institute (PCORI) funded the report (PCORI Publication No. 2018-SR-02). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or PCORI. Therefore, no statement in this report should be construed as an official position of PCORI, AHRQ, or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and AHRQ. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

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