Comparative efficacy of biological agents in methotrexate-refractory rheumatoid arthritis patients: a Bayesian mixed treatment comparison

Abstract

Background/AimsBiological agents (biologics) targeting proinflammatory signaling have emerged as an important treatment option in rheumatoid arthritis (RA). Despite the clinical effectiveness of biologics for patients with RA who do not respond to ‘traditional’ disease-modifying anti-rheumatic drugs (DMARDs), there are concerns regarding their cost and long-term safety. In this study, we aimed to compare the efficacy of various biologics and traditional DMARDs in RA patients refractory to methotrexate (MTX).MethodsFour DMARDs (hydroxychloroquine, sulfasalazine, MTX, lef lunomide) and five anti-tumor necrosis factor drugs (adalimumab, etanercept, golimumab, inf liximab, and certolizumab) were selected. A systematic search of published studies was performed from inception through July 2013. Randomized trials of adults with MTX-refractory RA comparing two or more of the selected medications were included. Among 7,938 titles identified, in total, 16 head-to-head trials were selected. Two reviewers independently abstracted the study data and assessed methodological quality using the Cochrane Risk of Bias. Comparative efficacy was analyzed using a Bayesian mixed treatment comparison (MTC).ResultsIn total, 9, 4, and 11 studies were included for the outcome measures of the Health Assessment Questionnaire (HAQ), Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) < 2.6 (remission), and American College of Rheumatology (ACR) 70 response, respectively. The treatments with the highest efficacy for each outcome measure were certolizumab combined with MTX, golimumab combined with MTX, and certolizumab combined with MTX, respectively.ConclusionsBased on MTC analysis, using data from published randomized controlled trials, certolizumab and golimumab combined with MTX showed the highest efficacy in the three outcome measures (HAQ, DAS28-ESR < 2.6, and ACR 70 response) in MTX-refractory RA patients.

The Efficacy and Safety of Mainstream Medications for Patients With cDMARD-Naïve Rheumatoid Arthritis: A Network Meta-Analysis

“…Thus, network meta-analysis (NMA) has been applied, which could combine all the available RCTs and evaluate the potential biologic drugs through not only direct but also indirect comparison. In recent years, several NMAs of biologic treatments for patients with RA have been published (Buckley et al, 2015 ; Lee and Bae, 2016 ; Migliore et al, 2016 ; Stevenson et al, 2016 ; Choi et al, 2017 ). Nevertheless, those studies only focused on combined treatments such as biologic therapies with MTX.…”

Auswahl klinischer und diagnostischer Ergebnisse bei entzündlichen Gelenkerkrankungen

“…Die Kostenfrage von Therapiemodalitäten tritt zunehmend in den Vordergrund der Diskussionen und fließen in die Empfehlungen ein [3,6,[10][11][12][13][14][15]. Diese Notwendigkeit erschließt sich über die Zulassung v. a. hochpreisiger spezifischer Medikamentenentwicklungen der letzten zwei Jahrzehnte.…”

A Network Meta-Analysis to Compare Effectiveness of Baricitinib and Other Treatments in Rheumatoid Arthritis Patients with Inadequate Response to Methotrexate

“…Since MTX is recommended as first-line therapy in RA in both the American College of Rheumatology (ACR) and EULAR guidelines, 7 , 8 comparative efficacy analyses of biologics and traditional DMARDs in MTX-inadequate response (IR) patients might provide additional insights regarding the management of RA. 9 Recent EULAR recommendations position JAK inhibitors as equal to bDMARDs; bDMARDs are no longer the preferred option for csDMARDs-IR patients who failed MTX, though the combination with MTX is preferred. 7 Despite the progress achieved in the treatment of RA there are still unmet needs, as well as a need for improved application of currently available treatments—including better treatment options employing novel mechanisms of actions targeting new pathways.…”