Effective pharmacotherapy is unlikely to improve mental health outcomes for most patients with rheumatoid arthritis (RA), according to data recently published in Arthritis and Rheumatology.
Researchers from King’s College in London, United Kingdom, conducted a meta-analysis to examine the efficacy of pharmacotherapy on improved mental health outcomes in RA. They systematically searched the CENTRAL, PsychINFO, Web of Science, Medline, Embase, and CINAHL databases for randomized trials examining disease-modifying antirheumatic drugs (DMARDs) in adult patients with RA. The primary outcome was mental health; the secondary outcome was self-reported physical health.
The investigators conducted a pairwise meta-analysis that created pooled effect sizes of all treatments compared with comparators (active or placebo). They also conducted a network meta-analysis, which provided effect size estimates of targeted biologic DMARDs (bDMARDs) compared with conventional synthetic DMARDs (csDMARDs). A total of 71 studies were identified, including 34,796 participants. In addition, 57 studies were included in the pairwise meta-analysis and 54 studies were included in the network meta-analysis.
Compared with csDMARDs, bDMARDs had small effects on mental health (standardized mean differences, 0.19 to 0.30) and moderate effects on self-reported physical health (standardized mean differences, 0.46 to 0.50). The network meta-analysis found that there were no significant differences in effectiveness between the bDMARD mode of action on mental or physical health.
When the analysis was limited to studies that examined bDMARDs vs no-treatment placebo controls, bDMARDs had a substantial benefit on physical health, measured by the Physical Component Summary, compared with mental health, measured by the Mental Component Summary (standardized mean differences, 0.52 vs 0.27, respectively). The authors noted that comparisons with csDMARD controls did not alter the findings from the total analysis (standardized mean differences, 0.47 vs 0.24).
“Our results suggest that [mental health outcomes] in patients with RA must be addressed and are unlikely to resolve with effective RA pharmacological disease management alone,” the authors noted. “Providing integrated, dedicated [mental health] care within routine practice is essential to achieve parity of esteem, valuing mental and physical health equally.”
Matcham F, Galloway J, Hotopf M, et al. The impact of targeted rheumatoid arthritis pharmacological treatment on mental health: a systematic review and network meta-analysis [published online June 6, 2018]. Arthritis Rheumatol. doi:10.1002/art.40565