MIDRA : influence of demographic and environmental factors on anti- tumor necrosis factor efficacy in rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

Thesis project : meta-analysis on the influence of demographic and environmental factors on anti- tumor necrosis factor efficacy in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a relatively frequent immune mediated disease with a prevalence of 3 to 8/1,000 patients. RA alters quality of life and increases cardiovascular, infectious and other morbidity risks. Anti- tumor necrosis factor (anti-TNF) drugs are efficient, yet primary or secondary failure is still a problem for one patient out of 3, even if exposition to anti-TNF drugs is correct. Therefore, searching for determinants of treatment response is essential.

The aim of this study is to highlight factors which could have an impact on the therapeutical response.

The treat-to-target strategy in rheumatoid arthritis has been proposed to increase the therapeutic efficacy while minimizing the risk of adverse events. Therefore, it is important to assess if demographics and environmental factors could influence anti- tumor necrosis factor treatment effect and the direction of this influence. These factors could therefore be considered when initiating anti-TNF drugs in rheumatoid arthritis in order to increase response rate and anticipate and avoid failure.