Objectives

The treatment goal for rheumatoid arthritis has undergone a dramatic change over recent years with the advent of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). This systematic review aims to discuss the comparative efficiency of new drugs versus the standard of care methotrexate.

Methods

Pubmed, Google Scholar, and Science Direct were searched, and 7072 records were retrieved. Randomized controlled trials published in the last five years with full-text papers, blinded studies, and studies with an open-label extension were included. Studies with a high risk of bias as calculated by the Cochrane risk of bias (RoB2) tool were excluded. The last database search was conducted on 21 August 2021.

Results

Fifteen studies were identified and analyzed by categorizing drugs into Janus kinase (JAK) inhibitors, tumour necrosis factor (TNF) inhibitors, and monoclonal antibodies with other targets (anti-GM-CSF receptor, anti-IL6 receptor, anti-IL-17 monoclonal antibodies), with a total of 7963 participants. Data were synthesized with tables and the PRISMA flow diagram. Our analysis included baricitinib, filgotinib, peficitinib, infliximab, certolizumab, sarilumab, tocilizumab namilumab, mavrilimumab, golimumab, and CNT06785.

Conclusions

These studies showed that except for CNT 06785 (anti-Interleukin 17A monoclonal antibody), biologic and targeted synthetic disease-modifying drugs combined with methotrexate or as monotherapy yield better clinical and radiographical outcomes. This systematic review does not discuss biosimilars and the adverse effects of biologic drugs in detail. Infections remain a significant adverse drug reaction of monoclonal antibodies. However, these drugs play a crucial role in adequately managing this disease for patients with severe arthritis.