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Toronto Notes 2019 Landmark Rheumatology Trials Rheumatology RH31 Landmark Rheumatology Trials
Trial
RHEUMATOID ARTHRITIS
ATTEST
ATTRACT
COMET
ERA
European Leflunomide Study Group FIN-RACo
Infliximab and MTX
Leflunomide Rheumatoid Arthritis Investigators Group
PREMIER Swefot
OSTEOARTHRITIS
GAIT Hyaluronan
SLE
Belimumab
BILAG open-RCT
Mycophenylate mofetil or intravenous cyclophosphamide
CONNECTIVE TISSUE DISEASES
Azathioprine or MTX maintenance for ANCA-associated vasculitis
CYCLOPS
Cyclophosphamide in scleroderma lung disease
Etanercept plus standard therapy for granulomatosis with polyangiitis
Mycophenylate mofetil vs. azathioprine for maintenance in ANCA-associated vasculitis
Rituximab versus cyclophosphamide for ANCA-associated vasculitis
GOUT
Febuxostat vs. allopurinol
ANKYLOSING SPONDYLITIS
Adalimumab ASSERT (rituximab) ATLAS (adalimumab) Infliximab in AS SPINE (etanercept) Sulfasalazine
Reference
Ann Rheum Dis 2008;67:1096-103 Lancet 1999;354:1932-9
Lancet 2008;372:375-82
NEJM 2000;343:1586-93
Lancet 1999;353:259-66
Lancet 1999;353:1568-73
NEJM 2000;343:1594-602
Arch Intern Med 1999;159:2542-50
Arthritis Rheum 2006;54:26-37 Lancet 2009;374:459-66
NEJM 2006;354:795-808
Ann Rheum Dis 2010;69:1097-102
Lancet 2011;377:721-31 Rheumatology 2010;49:723-32
NEJM 2005;353:2219-28
NEJM 2008;359:2790-803
Ann Intern Med 2009;69:670-80 NEJM 2006;354:2655-66 NEJM 2005;352:351-61
JAMA 2010;304:2381-8
NEJM 2010;363:221-32
NEJM 2005;353:2450-61
Arthritis Rheum 2006;54:2136-46 Arthritis Rheum 2005;52:582-91 J Rheumatol 2008;35:1346-53 Lancet 2002;359:1187-93
Ann Rheum Dis 2011;70:799-804 Arthritis Rheum 1995;38:618-27
Results
Abatacept and infliximab have similar efficacy in RA patients who have failed MTX Infliximab and MTX combined are more effective than MTX alone for patients with active RA Etanercept add-on therapy increases rates of remission in early RA
Etanercept more rapidly decreases symptoms in early RA compared to MTX
Leflunomide is equal in efficacy to sulphasalazine and superior to placebo
Combination therapy with DMARDs improves remission rates in early RA
Infliximab combined with MTX reduces joint damage in RA
Leflunomide is equivalent to MTX therapy and superior to placebo
Combination therapy with adalimumab and MTX is superior to either alone in patients with early RA Anti-TNF agents are more effective second-line therapy than DMARDs in patients who fail MTX
Glucosamine, chondroitin, and the combination of both are no more effective than placebo in treatment of knee OA
Hyaluronan injections do not improve disease activity in patients with moderate-severe knee OA
Treatment with belimumab reduces the incidence of BILAG A and B flares in patients with SLE compared to placebo
Low dose cyclosporine and azathioprine are equivalent in efficacy as maintenance therapy for SLE
Mycophenylate mofetil is more efficacious than cyclophosphamide in inducing remission of SLE nephritis
MTX and azathioprine are equally safe and effective as maintenance agents in ANCA vasculitis
Pulse cyclophosphamide therapy requires a lower cumulative dose compared to daily oral treatment in ANCA vasculitis
Cyclophosphamide therapy leads to transient improvements in lung function, skin scores, and overall health in patients with scleroderma
Etanercept is not effective in inducing remission in patients with ANCA vasculitis
Mycophenylate mofetil is less effective than azathioprine for maintaining disease in ANCA-associated vasculitis
Rituximab is not inferior to cyclophosphamide for induction of remission in ANCA vasculitis
Febuxostat is more effective than allopurinol at lowering serum urate, and has similar effectiveness on flare reduction
Adalimumab induced partial remission in 22% of AS patients
Sixty percent of patients treated with rituximab had a clinical response to the medication Compared to placebo, adalimumab significantly reduces pain and fatigue in AS patients
Infliximab induces regression of symptoms in 50% of patients and is superior to placebo Etanercept has short-term efficacy for patients with advanced AS and reduces disease severity Sulfasalazine is superior to placebo in treatment of patients with seronegative spondyloarthropathy