Abstract
Background/Purpose: To identify the best evidence on the efficacy of pharmacological interventions in reducing fatigue in people with I-RMDs and to summarise their safety in the identified studies to inform EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal disease (I-RMD).
Methods: Systematic review of adults with I-RMD conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction, and synthesis performed by two reviewers independently. Data pooled in statistical meta-analyses.
Results: From a total of 4,150 records, 454 were selected for full-text review, 105 fulfilled the inclusion criteria, and 19 RCTs were included in meta-analyses. Adalimumab was superior to placebo in reducing fatigue at 52 and 12 weeks (wk) in rheumatoid arthritis (RA) (mean difference [MD]=-2.25, p=0.03; MD=-3.03, p< 0.001; respectively) and psoriatic arthritis (MD=-3.16, p=0.26). Golimumab (24wk: MD=-5.27, p< 0.001), baricitinib (24wk: MD=-4.06, p< 0.001), sarilumab (24wk: MD=-3.15, p< 0.001), tocilizumab (24wk: MD=-3.69, p< 0.001) and tofacitinib (12wk: MD=-4.44, p< 0.001) were also superior to placebo in reducing fatigue in RA. A dose/effect relationship was observed for sarilumab, tocilizumab and tofacitinib. In spondyloarthritis, secukinumab was superior to placebo in reducing fatigue at 16wk (MD=-4.15, p< 0.001), with a dose/effect relationship also observed (Figure). The narrative results of the RCTs not included in the meta-analysis indicated that several other pharmacological interventions were efficacious in reducing fatigue, with reassuring safety results.
Conclusion: Pharmacological interventions are efficacious and safe for the management of fatigue in people with I-RMD.
Methods: Systematic review of adults with I-RMD conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction, and synthesis performed by two reviewers independently. Data pooled in statistical meta-analyses.
Results: From a total of 4,150 records, 454 were selected for full-text review, 105 fulfilled the inclusion criteria, and 19 RCTs were included in meta-analyses. Adalimumab was superior to placebo in reducing fatigue at 52 and 12 weeks (wk) in rheumatoid arthritis (RA) (mean difference [MD]=-2.25, p=0.03; MD=-3.03, p< 0.001; respectively) and psoriatic arthritis (MD=-3.16, p=0.26). Golimumab (24wk: MD=-5.27, p< 0.001), baricitinib (24wk: MD=-4.06, p< 0.001), sarilumab (24wk: MD=-3.15, p< 0.001), tocilizumab (24wk: MD=-3.69, p< 0.001) and tofacitinib (12wk: MD=-4.44, p< 0.001) were also superior to placebo in reducing fatigue in RA. A dose/effect relationship was observed for sarilumab, tocilizumab and tofacitinib. In spondyloarthritis, secukinumab was superior to placebo in reducing fatigue at 16wk (MD=-4.15, p< 0.001), with a dose/effect relationship also observed (Figure). The narrative results of the RCTs not included in the meta-analysis indicated that several other pharmacological interventions were efficacious in reducing fatigue, with reassuring safety results.
Conclusion: Pharmacological interventions are efficacious and safe for the management of fatigue in people with I-RMD.
| Original language | English |
|---|---|
| Pages (from-to) | 2374-2375 |
| Journal | Arthritis and Rheumatology |
| Volume | 75 |
| Issue number | suppl 9 |
| Publication status | Published - 2023 |