Tacrolimus for the treatment of active rheumatoid arthritis: A systematic review and meta-analysis of randomized controlled trials

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Abstract

Objective. The aim of this study was to assess the efficacy and safety of tacrolimus in patients with active rheumatoid arthritis (RA). Methods. We surveyed randomized controlled trials (RCTs) and open-label studies that examined the efficacy and toxicity of tacrolimus in disease-modifying anti-rheumatic drug (DMARD) - and methotrexate (MTX)-resistant or -intolerant patients with active RA patients using Medline, the Cochrane Controlled Trials Register, and by performing manual searches. Meta-analysis of RCTs was performed to determine treatment efficacy and safety outcomes. The results are presented as risk ratios (RRs), weighted mean differences (WMDs), or standardized mean differences (SMDs). Open-label studies were included in the systematic review. Results. The four RCTs included 1014 DMARD-resistant or -intolerant patients with DMARD-resistant or -intolerant RA. Median follow-up duration was 6 (range 46) months. American College of Rheumatology 20, 50, and 70 (ACR20, ACR50, and ACR70) response rates were significantly higher in the tacrolimus 3 mgday group (n 390) than in the controls (n 402) [primary efficacy outcome, ACR50; risk ratio (RR) 2.583, 95 confidence interval (CI) 1.0956.092, p 0.030], and efficacies in the tacrolimus 1.52 mgday group showed a similar pattern. Patients treated with tacrolimus withdrew from treatment because of adverse events (n 222) (primary safety outcome, withdrawals due to adverse events; RR 1.475, 95 CI 0.8952.187, p 0.053) more frequently than controls (n 231), although this was not significant. All four open-label studies found that tacrolimus was safe, well-tolerated, and provided clinical benefits. Conclusions. Tacrolimus, at dosages of 1.53 mgday, was found to be effective in DMARD-resistant or -intolerant patients with active RA.

Original languageEnglish
Pages (from-to)271-278
Number of pages8
JournalScandinavian Journal of Rheumatology
Volume39
Issue number4
DOIs
Publication statusPublished - 2010 Aug 1

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Tacrolimus
Meta-Analysis
Rheumatoid Arthritis
Randomized Controlled Trials
Antirheumatic Agents
Odds Ratio
Safety
Therapeutics
Confidence Intervals
Methotrexate

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

@article{e5763d4e3b464dff99e36ed48ec10215,
title = "Tacrolimus for the treatment of active rheumatoid arthritis: A systematic review and meta-analysis of randomized controlled trials",
abstract = "Objective. The aim of this study was to assess the efficacy and safety of tacrolimus in patients with active rheumatoid arthritis (RA). Methods. We surveyed randomized controlled trials (RCTs) and open-label studies that examined the efficacy and toxicity of tacrolimus in disease-modifying anti-rheumatic drug (DMARD) - and methotrexate (MTX)-resistant or -intolerant patients with active RA patients using Medline, the Cochrane Controlled Trials Register, and by performing manual searches. Meta-analysis of RCTs was performed to determine treatment efficacy and safety outcomes. The results are presented as risk ratios (RRs), weighted mean differences (WMDs), or standardized mean differences (SMDs). Open-label studies were included in the systematic review. Results. The four RCTs included 1014 DMARD-resistant or -intolerant patients with DMARD-resistant or -intolerant RA. Median follow-up duration was 6 (range 46) months. American College of Rheumatology 20, 50, and 70 (ACR20, ACR50, and ACR70) response rates were significantly higher in the tacrolimus 3 mgday group (n 390) than in the controls (n 402) [primary efficacy outcome, ACR50; risk ratio (RR) 2.583, 95 confidence interval (CI) 1.0956.092, p 0.030], and efficacies in the tacrolimus 1.52 mgday group showed a similar pattern. Patients treated with tacrolimus withdrew from treatment because of adverse events (n 222) (primary safety outcome, withdrawals due to adverse events; RR 1.475, 95 CI 0.8952.187, p 0.053) more frequently than controls (n 231), although this was not significant. All four open-label studies found that tacrolimus was safe, well-tolerated, and provided clinical benefits. Conclusions. Tacrolimus, at dosages of 1.53 mgday, was found to be effective in DMARD-resistant or -intolerant patients with active RA.",
author = "Lee, {Young Ho} and Woo, {J. H.} and Sungjae Choi and Ji, {Jong Dae} and Bae, {S. C.} and Song, {Gwan Gyu}",
year = "2010",
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pages = "271--278",
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T1 - Tacrolimus for the treatment of active rheumatoid arthritis

T2 - A systematic review and meta-analysis of randomized controlled trials

AU - Lee, Young Ho

AU - Woo, J. H.

AU - Choi, Sungjae

AU - Ji, Jong Dae

AU - Bae, S. C.

AU - Song, Gwan Gyu

PY - 2010/8/1

Y1 - 2010/8/1

N2 - Objective. The aim of this study was to assess the efficacy and safety of tacrolimus in patients with active rheumatoid arthritis (RA). Methods. We surveyed randomized controlled trials (RCTs) and open-label studies that examined the efficacy and toxicity of tacrolimus in disease-modifying anti-rheumatic drug (DMARD) - and methotrexate (MTX)-resistant or -intolerant patients with active RA patients using Medline, the Cochrane Controlled Trials Register, and by performing manual searches. Meta-analysis of RCTs was performed to determine treatment efficacy and safety outcomes. The results are presented as risk ratios (RRs), weighted mean differences (WMDs), or standardized mean differences (SMDs). Open-label studies were included in the systematic review. Results. The four RCTs included 1014 DMARD-resistant or -intolerant patients with DMARD-resistant or -intolerant RA. Median follow-up duration was 6 (range 46) months. American College of Rheumatology 20, 50, and 70 (ACR20, ACR50, and ACR70) response rates were significantly higher in the tacrolimus 3 mgday group (n 390) than in the controls (n 402) [primary efficacy outcome, ACR50; risk ratio (RR) 2.583, 95 confidence interval (CI) 1.0956.092, p 0.030], and efficacies in the tacrolimus 1.52 mgday group showed a similar pattern. Patients treated with tacrolimus withdrew from treatment because of adverse events (n 222) (primary safety outcome, withdrawals due to adverse events; RR 1.475, 95 CI 0.8952.187, p 0.053) more frequently than controls (n 231), although this was not significant. All four open-label studies found that tacrolimus was safe, well-tolerated, and provided clinical benefits. Conclusions. Tacrolimus, at dosages of 1.53 mgday, was found to be effective in DMARD-resistant or -intolerant patients with active RA.

AB - Objective. The aim of this study was to assess the efficacy and safety of tacrolimus in patients with active rheumatoid arthritis (RA). Methods. We surveyed randomized controlled trials (RCTs) and open-label studies that examined the efficacy and toxicity of tacrolimus in disease-modifying anti-rheumatic drug (DMARD) - and methotrexate (MTX)-resistant or -intolerant patients with active RA patients using Medline, the Cochrane Controlled Trials Register, and by performing manual searches. Meta-analysis of RCTs was performed to determine treatment efficacy and safety outcomes. The results are presented as risk ratios (RRs), weighted mean differences (WMDs), or standardized mean differences (SMDs). Open-label studies were included in the systematic review. Results. The four RCTs included 1014 DMARD-resistant or -intolerant patients with DMARD-resistant or -intolerant RA. Median follow-up duration was 6 (range 46) months. American College of Rheumatology 20, 50, and 70 (ACR20, ACR50, and ACR70) response rates were significantly higher in the tacrolimus 3 mgday group (n 390) than in the controls (n 402) [primary efficacy outcome, ACR50; risk ratio (RR) 2.583, 95 confidence interval (CI) 1.0956.092, p 0.030], and efficacies in the tacrolimus 1.52 mgday group showed a similar pattern. Patients treated with tacrolimus withdrew from treatment because of adverse events (n 222) (primary safety outcome, withdrawals due to adverse events; RR 1.475, 95 CI 0.8952.187, p 0.053) more frequently than controls (n 231), although this was not significant. All four open-label studies found that tacrolimus was safe, well-tolerated, and provided clinical benefits. Conclusions. Tacrolimus, at dosages of 1.53 mgday, was found to be effective in DMARD-resistant or -intolerant patients with active RA.

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