A mixed treatment comparison of the short-term efficacy of biologic disease
modifying anti-rheumatic drugs in established rheumatoid arthritis.
Author(s): Turkstra E, Ng SK, Scuffham PA.
Affiliation(s): Centre for Applied Health Economics, School of Medicine, Griffith Health
Institute, Griffith University, Australia. e.turkstra@griffith.edu.au
Publication date & source: 2011, Curr Med Res Opin. , 27(10):1885-97
BACKGROUND: The short-term efficacy of biological disease modifying
anti-rheumatic drugs (bDMARDs) for the treatment of established moderate to
severe rheumatoid arthritis (RA) has been demonstrated by various randomized
placebo or active treatment controlled trials. However, there is a lack of direct
comparison of these agents.
SCOPE: To compare the short-term efficacy of nine bDMARDs - abatacept,
adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab
and tocilizumab - in patients with established RA.
FINDINGS: A systematic review was conducted to obtain all available efficacy data
for each included bDMARD. Medline, EMBASE, and Cochrane clinical trials were
searched for trials in patients with RA. Twenty-seven trials were retrieved from
a systematic literature search and included in the meta-analysis. Mixed treatment
comparison (MTC) techniques were used to perform indirect comparisons. Analyses
were conducted to estimate the odds ratio of an ACR20, ACR50, and ACR70 response
at approximately six months if treated with a bDMARD compared with placebo or
methotrexate. Between-drug comparisons were also made. The analyses were
performed including recommended doses only (as per the product information). All
drugs except anakinra and golimumab demonstrated a statistically significant
advantage compared to control treatment for ACR20 responses. The between-drug
comparisons revealed a statistically significant advantage for certolizumab
compared to most bDMARDs for ACR20, ACR50 and ACR70 response and for etanercept
versus adalimumab and anakinra for ACR20 and ACR50 response, as well as a
statistically significant advantage for tocilizumab versus anakinra for ACR50
response.
CONCLUSION: The analyses, using MTC of efficacy of nine bDMARDs suggest that
treatment with anakinra is inferior to other bDMARDs and that etanercept and
certolizumab may be more effective than other bDMARDs. There are some limitations
of our analyses due to MTC assumptions, variations in trial design and the fact
that only ACR outcomes at six months were included.
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