Effect of monotherapy with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids on radiographic progression in rheumatoid arthritis: a network meta-analysis of 64 treatment arms from 31 randomized controlled trials
Authors' conclusion
Our study confirms that the present routine csDMARDs, methotrexate, leflunomide, and sulfasalazine, have inhibitory effects more favourable than placebo on joint destruction in RA.
Study context
- Population
- Patients with rheumatoid arthritis (RA) in randomized controlled trials (RCTs) of csDMARD or glucocorticoid (GC) monotherapy31 RCTs
- Comparison
- 13 conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), GC and placebo used in monotherapy
- Outcome
- Percentage annual radiographic progression rate (PARPR)
Methodological detailsmetaregressions, subgroup analyses for possible confounders, sensitivity analysis using SMD, WinBUGS software
- Metaregressions
- Subgroup analyses for possible confounders
- Sensitivity analysis using SMD
- WinBUGS software
Pooled result
As reported in the abstract
Radiographic progression (PARPR)
- Leflunomide, sulfasalazine and injected gold more favourable than placebo and neither more nor less favourable than methotrexate
- GC effect size equivalent to methotrexate, but not statistically better than placebo with percentage annual radiographic progression rate (PARPR)
- Azathioprine less favourable than methotrexate
- Remaining drugs not different from placebo or insufficiently investigated for robust conclusions
Original publication
Effect of monotherapy with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids on radiographic progression in rheumatoid arthritis: a network meta-analysis of 64 treatment arms from 31 randomized controlled trials. Scand J Rheumatol. Published 20 March 2026. doi:10.
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