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Master Thesis

Efficacité de la triple association Méthotrexate Sulfasalazine et Hydroxychloroquine dans la polyarthrite récente ayant une réponse insuffisante au Méthotrexate : méta-analyse d'essais contrôlés randomisés

Abstract : Objectives: To evaluate the efficacy of the triple synthetic Disease Modifying Anti-Rheumatic Drugs (sDMARD) combination Methotrexate, Sulfasalazine and Hydroxychloroquine versus a biologic DMARD (bDMARD) in the treatment of early rheumatoid arthritis. Methods: A systematic literature search was performed using the PubMed, and Cochrane database and abstracts presented at rheumatology scientific meetings until December 2013. Randomized controlled trials comparing the efficacy and the safety of biologic DMARD with the triple combination were included. Outcomes measure were Van der Heijde modified Sharp score (SHS), remission rate , ACR criteria response, adverse events. Differences between groups were assessed by standardized mean differences (SMD=difference between groups of mean outcome variation from baseline/Standard Deviation at baseline). Heterogeneity was assessed. Results: A total of 1378 abstract were screened. We extracted data from 5 trials including 1412 patients (648 in the triple combination group and 764 in the bDMARD group. At year one, clinical and radiological response are in favor of biological treatment. At year 2, there is less radiological progression in the bDMARD group (SMD=0.45 CI 95% [0.17, 0.72], p=0,001, I²=68%). The proportion of serious adverse effects was similar in both groups OR=1.02 (95%CI [0.68,1.52],p=0,92, I²=0%). Gastro-intestinal adverse events were higher in the triple combination group (OR=1,75 (CI 95% [0.73,4,21], p=0,21 ,I²=75%). Infectious adverse events were more frequent in the bDMARD group (OR=0,50 (CI 95% [0.35,0.70], p<0,0001, I²=36%). Conclusion: Biological treatment seems to be more efficient than triple combination in terms of radiological progression in RA with inadequate response to Methotrexate.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01150855
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Submitted on : Tuesday, May 12, 2015 - 9:25:17 AM
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Arnaud Mazouyes. Efficacité de la triple association Méthotrexate Sulfasalazine et Hydroxychloroquine dans la polyarthrite récente ayant une réponse insuffisante au Méthotrexate : méta-analyse d'essais contrôlés randomisés. Médecine humaine et pathologie. 2015. ⟨dumas-01150855⟩

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