Systematic review for the treatment of older rheumatoid arthritis patients informing the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis

To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults. PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed usi...

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Veröffentlicht in:	Modern rheumatology 2022-02, Vol.ahead-of-print (ahead-of-print), p.1-15
Hauptverfasser:	Sugihara, Takahiko, Kawahito, Yutaka, Morinobu, Akio, Kaneko, Yuko, Seto, Yohei, Kojima, Toshihisa, Ito, Hiromu, Kohno, Masataka, Nakayama, Takeo, Sobue, Yasumori, Nishida, Keiichiro, Matsushita, Isao, Murashima, Atsuko, Mori, Masaaki, Tanaka, Eiichi, Hirata, Shintaro, Kishimoto, Mitsumasa, Yamanaka, Hisashi, Kojima, Masayo, Harigai, Masayoshi
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Sprache:	eng
Schlagworte:	Aged Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - drug therapy biological DMARDs GRADE system Humans JAK inhibitors Japan meta-analysis Methotrexate - therapeutic use older RA Practice Guidelines as Topic Rheumatology
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creator	Sugihara, Takahiko Kawahito, Yutaka Morinobu, Akio Kaneko, Yuko Seto, Yohei Kojima, Toshihisa Ito, Hiromu Kohno, Masataka Nakayama, Takeo Sobue, Yasumori Nishida, Keiichiro Matsushita, Isao Murashima, Atsuko Mori, Masaaki Tanaka, Eiichi Hirata, Shintaro Kishimoto, Mitsumasa Yamanaka, Hisashi Kojima, Masayo Harigai, Masayoshi
description	To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults. PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications. Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of −2.79 (95% confidence interval [CI] − 3.74 to −1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.
doi_str_mv	10.1080/14397595.2021.1912922
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PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications. Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of −2.79 (95% confidence interval [CI] − 3.74 to −1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. 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Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. 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subjects	Aged Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - drug therapy biological DMARDs GRADE system Humans JAK inhibitors Japan meta-analysis Methotrexate - therapeutic use older RA Practice Guidelines as Topic Rheumatology
title	Systematic review for the treatment of older rheumatoid arthritis patients informing the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis
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