Efficacy and safety of non-conventional synthetic disease-modifying antirheumatic drugs in early active rheumatoid arthritis - a network meta-analysis

Q: How were eligible studies selected and analyzed?

Randomized controlled trials enrolling adults with early RA (<2 years) treated with biological DMARDs/JAK inhibitors versus conventional synthetic DMARDs were identified through searches of major databases and trial registries, then analyzed using Stata.

Q: Which treatment combinations showed notable efficacy and safety findings?

Adalimumab plus methotrexate showed the strongest effect for DAS28 remission, while tocilizumab plus methotrexate showed the highest ACR70 response; for safety, only tocilizumab plus methotrexate indicated a higher adverse event incidence, with no safety risks identified for other interventions.

Sep 30, 2026

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Objective To compare the clinical efficacy and safety of biological DMARDs and Janus kinase (JAK) inhibitors versus conventional synthetic DMARDs in patients with early rheumatoid arthritis (RA). Methods Systematic searches in PubMed, Web of Science, Cochrane Library, and EMBASE (to February 2025) plus trial registries; randomised controlled trials enrolling adults with early RA (<2 years). Results Twenty-one trials with nine interventions and 8,361 participants were included; some combinations showed superior efficacy to methotrexate, while safety signals were limited and conclusions remained constrained by trial quantity.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusion

Introduction

Background and unmet needs

Treatment landscape and rationale

Xu etal. BMC Rheumatology (2026) 10:5 [https://doi.org/10.1186/s41927-025-00603-x](https://doi.org/10.1186/s41927-025-00603-x) BMC Rheumatology SYSTEMATIC REVIEW Open Access Efficacy and safety of non-conventional synthetic disease-modifying antirheumatic drugs in early active rheumatoid arthritis: a network meta-analysis Haimei Xu 1†, Chen Li 1†, Rui Ding2†, Yaoxuan Zhan 1, Haiyan Liu 1, Xintong Liang 1, Yuanchen Niu 1, Ying Luo 1, Zhiqin Hu 1, Jin He 1, Liming Chen2*, Tenghua Wang 1* andYi Fang 1,2* Abstract Objective To compare the clinical efficacy and safety of biological disease-modifying antirheumatic drugs (DMARDs) and Janus kinase(JAK) inhibitors in patients with early rheumatoid arthritis (RA) . Methods A systematic search was conducted of PubMed, Web of Science, Cochrane Library, and EMBASE databases (up to February 2025), supplemented by searches of clinical trial registries. Eligible randomised controlled trials enrolled adults with early RA (< 2 years) treated with biological DMARDs/JAK inhibitors versus conventional synthetic DMARDs. Statistical analyses were conducted using Stata software (version 16. 0) . Results 21 eligible trials involving nine interventions and 8,361 participants were included in this metaanalysis. Multiple biological DMARDs demonstrated superior therapeutic efficacy compared to methotrexate. Adalimumab + methotrexate showed the most pronounced effect on DAS28 remission (OR 2. 90[95% CI 1.94–4. 33]; SUCRA 83 . 7%), while tocilizumab + methotrexate exhibited the highest efficacy in achieving ACR70 response (OR 4.41[95% CI 2 .29–8.49]; SUCRA 94 . 7%) . Regarding safety, only tocilizumab + methotrexate demonstrated a higher incidence of adverse events(OR 5. 11[95% CI 2.03–12. 86]; SUCRA 0 . 6%) . No safety risks were identified for other interventions. Due to the limited number of eligible clinical trials, the optimal treatment strategy remains inconclusive. Conclusion For patients with early RA and high disease activity, combination therapy with certain biological DMARDs demonstrated superior clinical efficacy compared to methotrexate. No noteworthy safety risks have been observed. More high-quality trials should be conducted to evaluate treatment strategies for individuals with early RA comprehensively. †Haimei Xu, Chen Li and Rui Ding contributed equally to this work. *Correspondence: Liming Chen [clm1003@163.com](clm1003@163.com)[ ](clm1003@163.com)Tenghua Wang [wangtenghua88@126.com](wangtenghua88@126.com)[ ](wangtenghua88@126.com)Yi Fang [phaseistudy@163.com](phaseistudy@163.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Xu et al. BMC Rheumatology (2026) 10:5 Page 2 of 11 Clinical trial number Not applicable Keywords Rheumatoid arthritis, Antirheumatic agents, Adult, Treatment outcome, Network meta-analysis Introduction Rheumatoid arthritis (RA) is a chronic sys

FAQs

What was the main objective of the network meta-analysis?

To compare the clinical efficacy and safety of biological DMARDs and JAK inhibitors with conventional synthetic DMARDs in early active rheumatoid arthritis.

How were eligible studies selected and analyzed?

Randomized controlled trials enrolling adults with early RA (<2 years) treated with biological DMARDs/JAK inhibitors versus conventional synthetic DMARDs were identified through searches of major databases and trial registries, then analyzed using Stata.

Which treatment combinations showed notable efficacy and safety findings?

Adalimumab plus methotrexate showed the strongest effect for DAS28 remission, while tocilizumab plus methotrexate showed the highest ACR70 response; for safety, only tocilizumab plus methotrexate indicated a higher adverse event incidence, with no safety risks identified for other interventions.

Sep 30, 2026

Upload by Indoniesian Boy