A systematic review of the effectiveness of adalimumab

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140 Appendix 1 Disease Activity Score (DAS) Original DAS DAS = 0.54(√ ——— RAI) + 0.065(total number of swollen joints out of 44) + 0.33(ln ESR) + 0.0072 (patient general health score where 0=best, 100=worst) where RAI refers to a graded score of joint tenderness for 53 joints, known as the Ritchie Articular Index. DAS based on 28 joint evaluations DAS 28-4 = 0.56(√ ——— TJC28 — ) + 0.28(√ ——— SJC28 — ) + 0.7ln(ESR) + 0.014 (patient general health score where 0=best, 100=worst) where TJC is tender joint count and SJC is swollen joint count. Where scores for general health are not available, or not measured, the following formula is used: DAS 28-3 = [0.56(√ ——— TJC28 — ) + 0.28(√ ——— SJC28 — ) + 0.7ln(ESR)]1.08 + 0.16 Radiographic assessment methods 209 Sharp score The simplified Sharp system, 210 which evaluates hand and wrist images, assesses 17 areas for erosions and 18 areas for joint space narrowing. Each joint is scored on a six-point scale as follows: 0 = no erosion; 1 = discrete erosion; 2 = two separate quadrants with erosions or 20–40% joint involvement; 3 = 3 separate quadrants with erosions or 41–60% joint involvement; 4 = all four quadrants with joint erosion or 61–80% joint involvement; and 5 = extensive destruction with over 80% joint involvement. The range of erosion scores for a patient with two hands and wrists is 0–170. For joint space narrowing each joint is scored using a five-point scale as follows: 0 = no narrowing; 1 = up to 25% narrowing; 2 = 26–65% narrowing; 3 = 66–99% narrowing; and 4 = complete narrowing. The range for joint space narrowing is therefore 0–144. This gives a total joint score in the range 0–314. Van der Heijde modified Sharp score In this case 16 joints are assessed in each hand and wrist and six joints in each foot. Erosions are scored 0–5 and depending on the affected surface area and 0–10 in the feet, yielding possible erosion scores of 0–160 for hands/wrists and 0–120 for feet (total 0–280). Joint space narrowing is assessed in 15 joints for each hand/wrist and six joints in each foot on a scale of 0–4. The range of possible joint space narrowing scores is in the range 0–168. This yields a possible total score in the range 0–448. 211 Larsen score In this method standard films are used to classify each joint into one of six possible categories (0 = normal, 5 = severely damaged). Any joint may be scored, but the focus is on hands and feet. In the hands each proximal interphalangeal joint and each metacarpophalangeal joint scores 0–5; each wrist joint scores 0–25 (the basic score is multiplied by 5): this gives a maximum score of 150 for two hands and wrists. In the feet each metatarsophalangeal joint is scored 0–5, giving a total score of 50 for two feet. This yields a possible total score in the range 0–200. Scott-modified Larsen 212 Scott and colleagues suggested minor modifications to the scale to improve correlation between scorers. It was proposed that grade 1 included erosions and cysts of less than 1 mm diameter and grade 2 included one or more erosions of more than 1 mm diameter.
Cochrane Library (CENTRAL) 2005 Issue 1 #1 rheumatoid NEXT arthritis in All Fields in all products #2 MeSH descriptor Arthritis, Rheumatoid, this term only in MeSH products #3 (#1 OR #2) #4 "tumor necrosis factor*" in All Fields in all products #5 "tumour necrosis factor*" in All Fields in all products #6 MeSH descriptor Receptors, Tumor Necrosis Factor, this term only in MeSH products #7 "anti tnf" in All Fields in all products #8 antitnf in All Fields in all products #9 infliximab in All Fields in all products #10 remicade in All Fields in all products #11 enbrel in All Fields in all products #12 etanercept in All Fields in all products #13 adalimumab in All Fields in all products #14 humira in All Fields in all products #15 (#4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14) #16 (#3 AND #15) Ovid MEDLINE(R) 1966 to February week 2 2005 1 arthritis rheumatoid/ 2 tumo?r necrosis factor.mp. 3 exp receptors tumor necrosis factor/ 4 anti TNF.mp. 5 infliximab.mp. 6 remicade.mp. 7 enbrel.mp. 8 etanercept.mp. 9 or/2-8 10 rheumatoid arthritis.mp. 11 1 or 10 12 9 and 11 13 randomized controlled trial.pt. 14 controlled clinical trial.pt. 15 randomized controlled trials.sh. 16 random allocation.sh. 17 double blind method.sh. 18 single blind method.sh. Appendix 2 Health Technology Assessment 2006; Vol. 10: No. 42 Searches: clinical effectiveness © Queen’s Printer and Controller of HMSO 2006. All rights reserved. 19 or/13-18 20 (animals not human).sh. 21 19 not 20 22 clinical trial.pt. 23 exp clinical trials/ 24 (clin$ adj25 trial$).ti,ab. 25 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. 26 placebo$.ti,ab. 27 random$.ti,ab. 28 placebos.sh. 29 research design.sh. 30 or/22-29 31 30 not 20 32 31 not 21 33 21 or 32 34 12 and 33 35 limit 34 to yr=2001 - 2005 36 adalimumab.mp. 37 humira.mp. 38 or/36-37 39 1 and 38 and 33 40 35 or 39 EMBASE (Ovid) 1980 to week 8 2005 1 arthritis rheumatoid/ 2 tumo?r necrosis factor.mp. 3 exp receptors tumor necrosis factor/ 4 anti TNF.mp. 5 infliximab.mp. 6 remicade.mp. 7 enbrel.mp. 8 etanercept.mp. 9 or/2-8 10 rheumatoid arthritis.mp. 11 1 or 10 12 9 and 11 13 adalimumab.mp. 14 humira.mp. 15 or/13-14 16 randomized controlled trial/ 17 exp clinical trial/ 18 exp controlled study/ 19 double blind procedure/ 20 randomization/ 21 placebo/ 141
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A systematic review of the effectiv
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A systematic review of the effectiv
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Objectives: This report reviews the
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Glossary and list of abbreviations
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viii Glossary and list of abbreviat
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Background Rheumatoid arthritis (RA
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increased risk of serious infection
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Summary RA is a common, chronic, in
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(IL-2) and interleukin-6 (IL-6), pr
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Assessment of response to DMARDs Re
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combination with methotrexate or al
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disease between clinic appointments
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14 Effectiveness in juvenile arthri
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16 Effectiveness adalimumab plus me
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18 Effectiveness Monoclonal Antibod
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20 TABLE 1 Description of included
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22 TABLE 2 Quality of included RCTs
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24 Effectiveness change in modified
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26 Effectiveness TABLE 4 Meta-analy
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28 Effectiveness Review: Adalimumab
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30 Effectiveness Review: Adalimumab
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32 TABLE 6 Effectiveness Descriptio
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34 TABLE 6 Effectiveness Descriptio
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36 TABLE 7 Effectiveness Quality of
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38 Effectiveness etanercept trials.
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40 Effectiveness TABLE 9 Summary of
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42 Effectiveness Review: Etanercept
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54 Effectiveness TABLE 11 Summary o
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56 TABLE 12 Description of included
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58 TABLE 13 Quality of included RCT
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60 Effectiveness per week and escal
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62 Effectiveness significant advant
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64 Effectiveness Review: Infliximab
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66 Effectiveness Review: Infliximab
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68 Effectiveness FIGURE 44 Malignan
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70 TABLE 17 Effectiveness Summary o
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Summary of review of existing econo
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TABLE 20 Summary of published ICERs
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TABLE 21 Published etanercept econo
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TABLE 23 Published economic analyse
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TABLE 25 Treatment sequences: adali
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management of RA, i.e. 1st and 2nd
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To estimate the long-term consequen
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TABLE 32 TNF inhibitors as last act
Page 105 and 106: TABLE 34 Basic structure of the mod
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Page 109 and 110: TABLE 39 Strategy set: adalimumab a
Page 111 and 112: TABLE 43 Beta distributions for HAQ
Page 113 and 114: TABLE 44 Early cessation of DMARDs:
Page 115 and 116: TABLE 46 Unit costs for tests and v
Page 117 and 118: following properties, according to
Page 119 and 120: TABLE 52 Base case: TNF inhibitors
Page 121 and 122: TABLE 54 Base case: TNF inhibitors
Page 123 and 124: TABLE 59 Third TNF inhibitor follow
Page 125 and 126: TABLE 65 Sensitivity analyses: TNF
Page 127 and 128: TABLE 67 Sensitivity analyses: TNF
Page 129: The substantial economic impact of
Page 133 and 134: Summary Effectiveness: principal fi
Page 135 and 136: inhibitors, although the incrementa
Page 137 and 138: introduce bias which generally exag
Page 139: Adalimumab, etanercept and inflixim
Page 143 and 144: 1. Jobanputra P, Barton P, Bryan S,
Page 145 and 146: 46. Young A, Dixey J, Cox N, Davies
Page 147 and 148: tumor necrosis factor therapy in th
Page 149 and 150: arthritis: a 12-week, double-blind,
Page 151 and 152: 171. Geborek P, Crnkic M, Petersson
Page 153 and 154: 216. Schotte H, Willeke P, Mickholz
Page 155: The Health Assessment Questionnaire
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Page 170 and 171: 154 Appendix 4 Infliximab plus MTX
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Page 181 and 182: TABLE 80 Kobelt et al., 2003 162 (c
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Page 185 and 186: TABLE 83 Kobelt et al., 2004 163 (c
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Page 197 and 198: TABLE 96 Variation 1: TNF inhibitor
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TABLE 132 Variation 10: TNF inhibit
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Volume 1, 1997 No. 1 Home parentera
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No. 3 Screening for sickle cell dis
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No. 25 A rapid and systematic revie
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A systematic review of the effectiveness of adalimumab

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