Excerpt

This report from the RTI-University of North Carolina Evidence-based Practice Center summarizes the evidence on the comparative efficacy, effectiveness, and harms of corticosteroids, synthetic DMARDs, and biologic DMARDs in the treatment of patients with either rheumatoid arthritis (RA) or psoriatic arthritis (PsA). The key questions (KQs) were developed through a public process in conjunction with the Scientific Resource Center at the Oregon Health and Science University. The KQs are as follows: KQ 1. For patients with rheumatoid arthritis or psoriatic arthritis, do drug therapies differ in their ability to reduce patient-reported symptoms, to slow or limit progression of radiographic joint damage, or to maintain remission? KQ 2. For patients with rheumatoid arthritis or psoriatic arthritis, do drug therapies differ in their ability to improve functional capacity or quality of life? KQ 3. For patients with rheumatoid arthritis or psoriatic arthritis, do drug therapies differ in harms, tolerability, adherence, or adverse effects? KQ 4. What are the comparative benefits and harms of drug therapies for rheumatoid arthritis and psoriatic arthritis in subgroups of patients based on stage of disease, history of prior therapy, demographics, concomitant therapies, or comorbidities?

Contents

• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • Background
  • Causes and Diagnosis
  • Treatment of Rheumatoid Arthritis and Psoriatic Arthritis
  • Scope and Key Questions
  • Organization of the Report
• 2. Methods
  • Topic Development
  • Study Selection
  • Applicability Assessment
  • Rating Strength of a Body of Evidence
  • Data Synthesis
• 3. Results
  • Key Question 1: Reductions in Symptoms, Limitations of Disease Progression, and Maintenance of Remission
  • Key Question 2: Functional Capacity and Quality of Life
  • Key Question 3: Harms, Tolerability, Adverse Effects or Adherence
  • Key Question 4: Benefits and Harms for Selected Populations
• 4. Discussion
  • Key Findings
  • Future Research
• References
• Appendixes
  • Appendix A. Peer Reviewers and Acknowledgments
  • Appendix B. Search Strings
  • Appendix C. Studies in an Included Meta-Analysis
  • Appendix D. Excluded Studies
  • Appendix E. Evidence Tables
  • Appendix F. Abstract-Only Studies
  • Appendix G. Quality Criteria
  • Appendix H. Characteristics of Studies With Poor Internal Validity
  • Appendix I. Clinical and Self-Reported Scales and Instruments Commonly Used in Studies of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis

Suggested citation:

Shekelle P, Maglione M, Bagley S, Suttorp M, Mojica WA, Carter J, Rolon C, Hilton L, Zhou A, Chen S, Glassman P. Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics. Comparative Effectiveness Review No. 6. (Prepared by the Southern California/RAND Evidence-based Practice Center under Contract No. 290-02-0003.) Rockville, MD: Agency for Healthcare Research and Quality. January 2007. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

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

This report is based on research conducted by the RTI-University of North Carolina Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0016). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

This report is intended as a reference and not as a substitute for 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.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

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