Prescription pattern assessment of pharmacotherapeutics used in the management of amyloidosis secondary to rheumatoid arthritis via systematic review and network meta-analysis.

Abstract

The study was conducted to determine the global prescribing behavior for amyloidosis secondary to rheumatoid arthritis (RA) and to determine the drug-specific treatment response. We checked comprehensive databases like Embase, Scopus, PubMed, and Web of Science to assess the research papers thoroughly. Studies happened from January 2001 to June 2025, were considered. Observational cohort studies reporting RA amyloidosis treatment were considered to assess naturalistic prescription patterns. Research paper quality was checked for risk of bias using a validated tool. Meta-analysis was performed with R. The study's primary outcome was to assess prescription pattern in a naturalistic, non-controlled manner. Secondary outcome was to assess the effect of different treatment agents on c-reactive protein (CRP), serum creatinine, and proteinuria in a pre-and post-treatment fashion. Twelve observational studies were identified with confirmed diagnoses in 463 RA amyloidosis patients. Etanercept was observed as the most prescribed drug. P-score for Infliximab was highest for creatinine-reducing capacity. The odds of reducing proteinuria were maximum with rituximab (OR = -4.35; C.I. = -10.24--1.54). Safety endpoint assessment showed a lower risk of infection with Etanercept (OR = 0.14; C.I. = -0.06-0.30) and highest mortality with cyclophosphamide (OR = 0.42; C.I. = -0.30-0.55). Heterogeneity was high in present meta-analysis (I² = 72%). Etanercept was most preferred treatment option for RA amyloidosis on both descriptive and inferential statistical assessment. Network meta-analysis can be utilized for prescription pattern assessments.