Estudios primarios incluidos en esta revisión sistemática

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Estudio primario

No clasificado

Gait characteristics under different walking conditions: Association with the presence of cognitive impairment in community-dwelling older people.

Revista PloS one
Año 2017
Enlaces Pubmed DOI PubMed Central

Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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BACKGROUND: Gait characteristics measured at usual pace may allow profiling in patients with cognitive problems. The influence of age, gender, leg length, modified speed or dual tasking is unclear. METHODS: Cross-sectional analysis was performed on a data registry containing demographic, physical and spatial-temporal gait parameters recorded in five walking conditions with a GAITRite® electronic carpet in community-dwelling older persons with memory complaints. Four cognitive stages were studied: cognitively healthy individuals, mild cognitive impaired patients, mild dementia patients and advanced dementia patients. RESULTS: The association between spatial-temporal gait characteristics and cognitive stages was the most prominent: in the entire study population using gait speed, steps per meter (translation for mean step length), swing time variability, normalised gait speed (corrected for leg length) and normalised steps per meter at all five walking conditions; in the 50-to-70 years old participants applying step width at fast pace and steps per meter at usual pace; in the 70-to-80 years old persons using gait speed and normalised gait speed at usual pace, fast pace, animal walk and counting walk or steps per meter and normalised steps per meter at all five walking conditions; in over-80 years old participants using gait speed, normalised gait speed, steps per meter and normalised steps per meter at fast pace and animal dual-task walking. Multivariable logistic regression analysis adjusted for gender predicted in two compiled models the presence of dementia or cognitive impairment with acceptable accuracy in persons with memory complaints. CONCLUSION: Gait parameters in multiple walking conditions adjusted for age, gender and leg length showed a significant association with cognitive impairment. This study suggested that multifactorial gait analysis could be more informative than using gait analysis with only one test or one variable. Using this type of gait analysis in clinical practice could facilitate screening for cognitive impairment.

Estudio primario

No clasificado

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.

Revista Annals of the Rheumatic Diseases
Año 2017
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Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 4 Revisiones sistemáticas Revisiones sistemáticas (4 referencias)

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Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.

Estudio primario

No clasificado

One-Year Clinical Outcomes in 1623 Patients with Inflammatory Arthritis Who Switched from Originator to Biosimilar Etanercept - an Observational Study from the Danish Danbio Registry

Revista Arthritis Rheum
Año 2017

Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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Estudio primario

No clasificado

Difference in the risk of serious infections in patients with rheumatoid arthritis treated with adalimumab, infliximab and etanercept: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry.

Revista Annals of the rheumatic diseases
Año 2013
Enlaces Pubmed DOI

Este artículo está incluido en 2 Revisiones sistemáticas Revisiones sistemáticas (2 referencias)

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BACKGROUND: Tumour necrosis factor (TNF)-inhibiting therapy increases the risk of serious infections in rheumatoid arthritis (RA). However, it is not clear whether this risk differs between TNF inhibitors. OBJECTIVE: To analyse whether the risk of serious infections in patients with RA treated with an anti-TNF inhibitor is different for adalimumab, infliximab and etanercept. METHODS: Data from the Dutch RA monitoring registry were used. Incidence rates were calculated from the observed number of first serious infections and follow-up time up to 5 years. A Cox proportional hazards model with time-to-first-serious infection was used to estimate risk differences among the anti-TNF treatment groups, with correction for confounders. RESULTS: The unadjusted incidence rate of a first serious infection in patients with RA per 100 patient-years was 2.61 (95% CI 2.21 to 3.00) for adalimumab, 3.86 (95% CI 3.33 to 4.40) for infliximab and 1.66 (95% CI 1.09 to 2.23) for etanercept. Age, year of starting anti-TNF therapy, comorbidities at baseline and disease activity score 28 over time were included as confounders. No difference in risk for serious infections was found between adalimumab and infliximab with an adjusted HR (adjHR) of 0.90 (95% CI 0.55 to 1.48). The risk of serious infections was significantly lower in etanercept than in both infliximab (adjHR=0.49 (95% CI 0.29 to 0.83)) and adalimumab (adjHR=0.55 (95% CI 0.44 to 0.67)). CONCLUSIONS: The risk of serious infections in patients with RA treated with adalimumab or infliximab was similar, while the risk of serious infections in patients with RA treated with etanercept was lower than with both adalimumab and infliximab.

Estudio primario

No clasificado

A comparative effectiveness study of adalimumab, etanercept and infliximab in biologically naive and switched rheumatoid arthritis patients: results from the US CORRONA registry.

Revista Annals of the rheumatic diseases
Año 2012
Enlaces Pubmed DOI

Este artículo está incluido en 4 Revisiones sistemáticas Revisiones sistemáticas (4 referencias)

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PURPOSE: To compare the effectiveness of anti-tumour necrosis factor (TNF) agents in biologically naive and 'switched' rheumatoid arthritis (RA) patients. METHODS: RA patients enrolled in the CORRONA registry newly prescribed adalimumab (n=874), etanercept (n=640), or infliximab (n=728) were stratified based on previous anti-TNF use. Clinical effectiveness at 6, 12 and 24 months was examined using the modified American College of Rheumatology response criteria (mACR20/50/70) and achievement of remission (28-joint disease activity score (DAS28) and clinical disease activity index (CDAI)) in unadjusted and adjusted analyses. The persistence of anti-TNF treatment was examined using Cox proportional hazard models. RESULTS: Among 2242 patients (1475 biologically naive, 767 switchers), mACR20, 50 and 70 responses were similar (p>0.05) for adalimumab, etanercept and infliximab at all time points, as were rates of CDAI and DAS28 remission (p>0.05). Response and remission outcomes were consistently inferior for switched versus biologically naive patients. The adjusted OR for achieving an mACR20 response was 0.54 (95% CI 0.38 to 0.76) in first-time switchers and 0.42 (95% CI 0.23 to 0.78) in second-time switchers versus biologically naive patients at 6 months. The adjusted OR for achieving DAS28 remission were 0.29 (95% CI 0.15 to 0.58) for first-time switchers and 0.26 (95% CI 0.08 to 0.84) for second-time switchers. Persistence was higher in biologically naive patients, for whom persistence was highest with infliximab. CONCLUSIONS: No differences in rates of drug response or remission were observed among the three anti-TNF. Infliximab was associated with greater persistence in biologically naive patients. Response, remission and persistence outcomes were diminished for patients who switched anti-TNF.

Estudio primario

No clasificado

Ten years with biologics: to whom do data on effectiveness and safety apply?

Revista Rheumatology (Oxford, England)
Año 2011
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Este artículo está incluido en 2 Revisiones sistemáticas Revisiones sistemáticas (2 referencias)

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OBJECTIVES: During the past decade, the position of biologics in the therapeutic armamentarium, the number of approved indications and the number of available biologics have changed. Available data on (long-term) safety might thus pertain to patient populations not comparable with contemporary patients. The aim of this study was to assess the extent to which contemporary patients who start or switch biologic therapies are comparable with those patients who gave rise to the currently available data on effectiveness and safety. METHODS: We identified all adult patients with RA (n=9612), PsA (n=1417) and other SpA (n=1652) initiating a first biologic therapy between 1 January 1999 and 31 December 2008, registered in the Swedish Biologics Register (ARTIS), including information on demographics, disease characteristics and 1-year risk of first-line treatment discontinuation. RESULTS: Over calendar time, measures of disease activity at start declined substantially for all indications, and diminished between first-, second- and third-line therapy starts. One-year risks of first-line therapy discontinuation increased. Switchers to anti-TNF and non-TNF biologics had different comorbidities. Despite <50% drug retention at 5 years, most patients remained exposed to some biologic. CONCLUSIONS: The trends in baseline characteristics and drug retention underscores that any effects of biologics, including comparison between different biologics, must be interpreted in light of the characteristics of the population treated. The observed differences further call for continued vigilance to properly evaluate the safety profiles of biologic treatments as they are currently used. Exposure to multiple biologics presents a challenge for attribution of long-term effects.

Estudio primario

No clasificado

La comparación directa de la respuesta al tratamiento, las tasas de remisión y la adherencia al tratamiento en pacientes con artritis reumatoide tratados con adalimumab, etanercept, infliximab o: resultados de ocho años de vigilancia de la práctica clínica en el nivel nacional registro danés DANBIO.

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Revista Arthritis and rheumatism
Año 2010
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Este artículo está incluido en 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias) 2 Síntesis amplias Síntesis amplias (2 referencias)

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OBJETIVO: Comparar los inhibidores del factor de necrosis tumoral alfa directamente en relación con las tasas de respuesta al tratamiento, remisión, y la tasa de supervivencia de drogas en pacientes con artritis reumatoide (AR), e identificar los factores pronósticos clínicos para la respuesta. MÉTODOS: El registro DANBIO nacional recoge datos sobre pacientes de reumatología que recibieron la atención habitual. Para el presente estudio, se incluyeron pacientes de DANBIO que tenían RA (n = 2326) en los que se inició el primer tratamiento biológico (29% adalimumab recibida, el 22% recibieron etanercept, y el 49% recibieron infliximab). Se identificaron predictores basales de la respuesta al tratamiento. Se calcularon los odds ratios (OR) para las respuestas clínicas y ratios de remisión y de riesgo (CR) para la retirada del fármaco, corregido por la edad, la duración de la enfermedad, el Disease Activity Score en 28 articulaciones (DAS28), seropositividad, metotrexato concomitante y prednisolona, ​​número de medicamentos anteriores modificadores de la enfermedad, central y el estado funcional (puntuación en el Cuestionario de Evaluación de la Salud). RESULTADOS: El setenta por ciento de mejora de acuerdo con el American College of Rheumatology criterios (una respuesta ACR70) se logró en el 19% de los pacientes después de 6 meses. La edad avanzada, el tratamiento concomitante prednisolona, ​​y el estado funcional bajo al inicio del estudio fueron predictores negativos. Las RUP (95% intervalo de confianza [IC del 95%]) para una respuesta ACR70 fueron (IC del 95%: 1,52 a 2,76) 2,05 para adalimumab frente a infliximab, 1,78 (IC del 95%: 1,28 a 2,50) para etanercept frente a infliximab, y 1,15 (95 % CI 0,82-1,60) para adalimumab frente a etanercept. Se observaron los predictores y RUP similares para una buena respuesta de acuerdo a los criterios de la Liga Europea contra el Reumatismo, DAS28 remisión clínica y la remisión de Enfermedades Índice de Actividad. A los 48 meses, las horas para la retirada del fármaco fueron 1.98 para infliximab frente a etanercept (95% 1,63-2,40), 1,35 para infliximab frente adalimumab (IC del 95%: 1,15 a 1,58) y 1,47 para adalimumab frente a etanercept (IC del 95%: 1,20 a 1,80 ). CONCLUSIÓN: Mayor de edad, el estado funcional bajo, y el tratamiento de prednisolona concomitante fueron predictores negativos de una respuesta clínica y remisión. Infliximab tenido las tasas más bajas de la respuesta al tratamiento, remisión de la enfermedad, y el cumplimiento del tratamiento, adalimumab tenían las mayores tasas de respuesta al tratamiento y remisión de la enfermedad, y etanercept tenido las tasas de supervivencia de drogas más largas. Estos resultados fueron consistentes tras la corrección de los factores de confusión y los análisis de sensibilidad y en las medidas de resultado y los tiempos de seguimiento.

Estudio primario

No clasificado

La comparación de las tasas de retención de drogas y las causas de la interrupción del tratamiento entre los agentes del factor de necrosis anti-tumoral en la artritis reumatoide.

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Revista Arthritis and rheumatism
Año 2009
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Este artículo está incluido en 7 Revisiones sistemáticas Revisiones sistemáticas (7 referencias) 2 Síntesis amplias Síntesis amplias (2 referencias)

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OBJETIVO: inhibidores del factor de necrosis tumoral (TNF) han revolucionado el tratamiento de la artritis reumatoide severa (RA), y sin embargo la interrupción del tratamiento es común. El objetivo de este estudio fue comparar las tasas de retención de tratamiento y las causas específicas de la suspensión anti-TNF en una cohorte de base poblacional de la RA. Métodos: Todos los pacientes tratados con etanercept, infliximab, adalimumab o dentro de la Clínica cohorte de Gestión de Calidad RA Suiza entre 1997 y 2006 se incluyeron en el estudio. Las causas de la interrupción del tratamiento fueron clasificadas como acontecimientos adversos (AA) o causas no tóxicos, y además subdivididos en categorías específicas. Las causas específicas de la interrupción del tratamiento se analizaron mediante un modelo de riesgos proporcionales de Cox y se ajustaron los factores de confusión potenciales. RESULTADOS: Un total de 2.364 ciclos de tratamiento anti-TNF se reunieron los criterios de inclusión. La interrupción del tratamiento se informó de 803 veces: 309 con etanercept, 249 con infliximab y 245 con adalimumab. Ineficacia de Drogas representó la principal causa de la interrupción del tratamiento (55,8% de los casos). La mediana del tiempo de recibir la terapia anti-TNF fue de 37 meses, pero las tasas de interrupción difería entre los 3 agentes anti-TNF (P <0,001), con tasas más cortos de retención para infliximab (hazard ratio [HR] intervalo de confianza del 1,24, el 99% [99 IC%] 1,01-1,51). Las causas específicas de la interrupción del tratamiento revelaron un aumento del riesgo de acontecimientos adversos con infliximab (RR 1,4, IC 99% 1,003 a 1,96), debido principalmente a un aumento del riesgo de perfusión o reacciones alérgicas (HR 2.11, IC 99% 1,23-3,62). Otras causas de discontinuación fueron distribuidos en partes iguales entre los agentes anti-TNF. CONCLUSIÓN: En esta población, el infliximab se asoció con mayores tasas de abandono del tratamiento en comparación con etanercept y adalimumab, que se debe principalmente a un aumento del riesgo de perfusión o reacciones alérgicas.

Estudio primario

No clasificado

Changing patterns of tumor necrosis factor inhibitor use in 9074 patients with rheumatoid arthritis

Revista The Journal of rheumatology
Año 2009
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Este artículo está incluido en 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias)

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Objective. Patients with rheumatoid arthritis (RA) commonly switch between tumor necrosis factor (TNF) inhibitors after failing to control disease activity. Much of the clinical data that support switching to a second TNF agent when one agent fails to work has come from small, short-term studies. We utilized a US insurance claims database to determine patterns of use such as dose escalation, time to discontinuation, and switching between TNF inhibitors in patients with RA. Methods.A retrospective analysis was performed using an insurance claims database in the US from 2000 to 2005. TNF inhibitor use, time to switch, dose escalation, and continuation times were analyzed in patients with RA. Results. Nine thousand seventy-four patients with RA started TNF inhibitors during the period 2000 to 2005. Etanercept was the most commonly used TNF inhibitor; infliximab had the highest duration of continuation, about 50% at 2 years. In addition, infliximab showed higher rates of dose escalation compared to etanercept and adalimumab. For all TNF inhibitors, time to switching decreased from 2000 to 2005. Conclusion. TNF inhibitor use patterns changed from 2000 to 2005, with more frequent changes among the different TNF inhibitors and a shorter duration of treatment before the change. Only about 50% of TNF inhibitors are still continued at 2 years, reflecting the difference between randomized clinical trials and real-world experience. The Journal of Rheumatology Copyright © 2009. All rights reserved.

Estudio primario

No clasificado

Anti-TNF biologic agents: still the therapy of choice for rheumatoid arthritis.

Autores Taylor PC , Feldmann M
Revista Nature reviews. Rheumatology
Año 2009
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Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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Cytokines such as tumor necrosis factor (TNF) are expressed at high levels in rheumatoid joint tissue, where they contribute significantly to inflammation and articular destruction. TNF was the first cytokine to be fully validated as a therapeutic target for rheumatoid arthritis (RA). In nearly a decade since anti-TNF agents-such as infliximab, etanercept and adalimumab-were launched as the first biologic therapies to be licensed for RA, much has been learnt about how and when in the disease course this class of drug can be used to achieve optimal therapeutic benefit. Other cytokine targets, such as interleukin (IL)-6 or IL-1, have also been validated and several are in the process of being tested. However, TNF is likely to remain the preferred target of first-line biologic therapy for the foreseeable future as, in populations with active RA despite ongoing, nonbiologic, DMARD therapy, biologic inhibition of either IL-6 or IL-1 demonstrates no obviously superior outcomes to TNF blockade. Furthermore, new approaches to blockade of signaling mediated by bioactive TNF might have the potential to generate higher-magnitude clinical responses than are currently elicited.