Treating Early Undifferentiated Arthritis: A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence

Maria A Lopez-Olivo, Voke Kakpovbia-Eshareturi, Jude K des Bordes, Andrea Barbo, Robin Christensen, Maria E Suarez-Almazor

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated arthritis (UA).

METHODS: We searched 4 electronic databases from inception to January 2016, clinicaltrials.gov, and bibliographies of relevant articles. Two reviewers independently screened and evaluated the studies. The primary outcome was development of rheumatoid arthritis (RA).

RESULTS: Nine studies were included. Interventions included methotrexate, abatacept, infliximab, intraarticular or intramuscular glucocorticoids, and radiation synovectomy. Treating patients resulted in lower rates of RA at 12 months compared to placebo or no treatment (odds ratio [OR] 0.49 [95% confidence interval (95% CI) 0.26, 0.90]). From direct meta-analysis, patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13 [95% CI 0.03, 0.48]). This difference was no longer significant at 30 or 60 months. From indirect comparisons, most interventions showed decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16 [95% CI 0.08, 0.33]) and intramuscular methylprednisolone (OR 0.72 [95% CI 0.53, 0.99]). Most individual interventions included a limited number of studies.

CONCLUSION: Treating patients with UA resulted in a statistically significant delay in the development of RA, with the largest effect observed for methotrexate. These findings suggest that there is a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.

Original languageEnglish
JournalArthritis Care and Research
Volume70
Issue number9
Pages (from-to)1355-1365
ISSN0893-7524
DOIs
Publication statusPublished - Sep 2018
Externally publishedYes

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Meta-Analysis
Methotrexate
Odds Ratio
Confidence Intervals
Placebos
Glucocorticoids
Databases

Cite this

Lopez-Olivo, M. A., Kakpovbia-Eshareturi, V., des Bordes, J. K., Barbo, A., Christensen, R., & Suarez-Almazor, M. E. (2018). Treating Early Undifferentiated Arthritis: A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence. Arthritis Care and Research, 70(9), 1355-1365. https://doi.org/10.1002/acr.23474
Lopez-Olivo, Maria A ; Kakpovbia-Eshareturi, Voke ; des Bordes, Jude K ; Barbo, Andrea ; Christensen, Robin ; Suarez-Almazor, Maria E. / Treating Early Undifferentiated Arthritis : A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 9. pp. 1355-1365.
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abstract = "OBJECTIVE: We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated arthritis (UA).METHODS: We searched 4 electronic databases from inception to January 2016, clinicaltrials.gov, and bibliographies of relevant articles. Two reviewers independently screened and evaluated the studies. The primary outcome was development of rheumatoid arthritis (RA).RESULTS: Nine studies were included. Interventions included methotrexate, abatacept, infliximab, intraarticular or intramuscular glucocorticoids, and radiation synovectomy. Treating patients resulted in lower rates of RA at 12 months compared to placebo or no treatment (odds ratio [OR] 0.49 [95{\%} confidence interval (95{\%} CI) 0.26, 0.90]). From direct meta-analysis, patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13 [95{\%} CI 0.03, 0.48]). This difference was no longer significant at 30 or 60 months. From indirect comparisons, most interventions showed decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16 [95{\%} CI 0.08, 0.33]) and intramuscular methylprednisolone (OR 0.72 [95{\%} CI 0.53, 0.99]). Most individual interventions included a limited number of studies.CONCLUSION: Treating patients with UA resulted in a statistically significant delay in the development of RA, with the largest effect observed for methotrexate. These findings suggest that there is a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.",
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Lopez-Olivo, MA, Kakpovbia-Eshareturi, V, des Bordes, JK, Barbo, A, Christensen, R & Suarez-Almazor, ME 2018, 'Treating Early Undifferentiated Arthritis: A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence', Arthritis Care and Research, vol. 70, no. 9, pp. 1355-1365. https://doi.org/10.1002/acr.23474

Treating Early Undifferentiated Arthritis : A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence. / Lopez-Olivo, Maria A; Kakpovbia-Eshareturi, Voke; des Bordes, Jude K; Barbo, Andrea; Christensen, Robin; Suarez-Almazor, Maria E.

In: Arthritis Care and Research, Vol. 70, No. 9, 09.2018, p. 1355-1365.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Treating Early Undifferentiated Arthritis

T2 - A Systematic Review and Meta-Analysis of Direct and Indirect Trial Evidence

AU - Lopez-Olivo, Maria A

AU - Kakpovbia-Eshareturi, Voke

AU - des Bordes, Jude K

AU - Barbo, Andrea

AU - Christensen, Robin

AU - Suarez-Almazor, Maria E

N1 - © 2017, American College of Rheumatology.

PY - 2018/9

Y1 - 2018/9

N2 - OBJECTIVE: We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated arthritis (UA).METHODS: We searched 4 electronic databases from inception to January 2016, clinicaltrials.gov, and bibliographies of relevant articles. Two reviewers independently screened and evaluated the studies. The primary outcome was development of rheumatoid arthritis (RA).RESULTS: Nine studies were included. Interventions included methotrexate, abatacept, infliximab, intraarticular or intramuscular glucocorticoids, and radiation synovectomy. Treating patients resulted in lower rates of RA at 12 months compared to placebo or no treatment (odds ratio [OR] 0.49 [95% confidence interval (95% CI) 0.26, 0.90]). From direct meta-analysis, patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13 [95% CI 0.03, 0.48]). This difference was no longer significant at 30 or 60 months. From indirect comparisons, most interventions showed decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16 [95% CI 0.08, 0.33]) and intramuscular methylprednisolone (OR 0.72 [95% CI 0.53, 0.99]). Most individual interventions included a limited number of studies.CONCLUSION: Treating patients with UA resulted in a statistically significant delay in the development of RA, with the largest effect observed for methotrexate. These findings suggest that there is a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.

AB - OBJECTIVE: We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated arthritis (UA).METHODS: We searched 4 electronic databases from inception to January 2016, clinicaltrials.gov, and bibliographies of relevant articles. Two reviewers independently screened and evaluated the studies. The primary outcome was development of rheumatoid arthritis (RA).RESULTS: Nine studies were included. Interventions included methotrexate, abatacept, infliximab, intraarticular or intramuscular glucocorticoids, and radiation synovectomy. Treating patients resulted in lower rates of RA at 12 months compared to placebo or no treatment (odds ratio [OR] 0.49 [95% confidence interval (95% CI) 0.26, 0.90]). From direct meta-analysis, patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13 [95% CI 0.03, 0.48]). This difference was no longer significant at 30 or 60 months. From indirect comparisons, most interventions showed decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16 [95% CI 0.08, 0.33]) and intramuscular methylprednisolone (OR 0.72 [95% CI 0.53, 0.99]). Most individual interventions included a limited number of studies.CONCLUSION: Treating patients with UA resulted in a statistically significant delay in the development of RA, with the largest effect observed for methotrexate. These findings suggest that there is a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.

U2 - 10.1002/acr.23474

DO - 10.1002/acr.23474

M3 - Journal article

C2 - 29161466

VL - 70

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JO - Arthritis Care and Research

JF - Arthritis Care and Research

SN - 0893-7524

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ER -