Long-term efficacy and cost-effectiveness of infliximab as first-line treatment in rheumatoid arthritis: systematic review and meta-analysis

Abstract

Introduction: Early biological treatment of rheumatoid arthritis (RA) may reverse the autoimmune response in some patients resulting in favorable long-term outcomes. Although the cost-effectiveness of this strategy has been questioned, biosimilar entries warrant the revision of clinical and pharmaco-economic evidence. Areas covered: We conducted a systematic review of randomized controlled trials (RCTs) published up to 24 May 2018 in Pubmed, EMBASE and Cochrane CENTRAL, comparing infliximab with non-biological therapy in patients with RA naïve to methotrexate. We performed meta-analyses for efficacy outcomes at month 6 and years 1 and 2. Six RCTs were identified, involving 1832 patients. At month 6 ACR70 response and remission, and at year 1 ACR20/ACR70 responses and remission were improved significantly with first-line infliximab versus control. The differences were not significant at year 2. We reviewed cost-utility studies, up to 31 October 2018 in PubMed, Cochrane CENTRAL and the CRD HTA databases. Four studies indicated that first-line use of originator infliximab calculated at 2005-2008 prices was not cost-effective. Expert opinion: We demonstrated the efficacy benefits of first-line infliximab therapy up to 1 year in methotrexate-naïve RA. We highlighted the need for standardized reporting of outcomes and conducting cost-effectiveness analyses of first-line biosimilar therapy in RA.

Novel Anti-Cytokine Strategies for Prevention and Treatment of Respiratory Allergic Diseases

“…IL-6 and TNF are key pro-inflammatory cytokines implicated in neutrophilia, extracellular matrix production and chronic inflammation during severe asthma. In spite of possible side effects, TNF neutralization is a golden standard in treating rheumatoid arthritis, psoriasis and inflammatory bowel disease therapy ( 100 ). Anti-IL-6 drugs are also approved in RA ( 101 ).…”

<p>Intraarticular Injection of Infliximab-Loaded Thermosensitive Hydrogel Alleviates Pain and Protects Cartilage in Rheumatoid Arthritis</p>

“…39 Infliximab is a TNF inhibitor approved for the treatment of moderate-tosevere RA in the United States of America since 1999. 40 In particular, IFX, which is a human-mouse chimeric monoclonal antibody, can rapidly bind to TNF-α with high affinity in both soluble and permeable forms, resulting in the generation of stable complexes and thus inhibiting the binding of TNF-α to receptors and depriving its biological activity. In addition, both in vitro and in vivo experiments have shown that in cells expressing the permeable form of TNF-α, it could be dissolved following binding to IFX.…”

“…In addition, both in vitro and in vivo experiments have shown that in cells expressing the permeable form of TNF-α, it could be dissolved following binding to IFX. [40][41][42] Herein, administration of HG-IFX was shown to reduce inflammation by directly inhibiting TNF-α, thereby downregulating the expression of a series of pain-related inflammatory cytokines (eg, IL-1β, IL-6, and IL-17) and alleviating the pain symptoms of RA.…”

Marine-Derived Biologically Active Compounds for the Potential Treatment of Rheumatoid Arthritis

“…The patients treated with infliximab demonstrate a significant reduction of adhesion molecules, including IL-8, IL-6, MCP-1, and IL-1. Despite the safety profile, the infliximab exhibits severe adverse effects such as reactivation of tuberculosis or hepatitis B, cancers, and lymphoma [47]. Adalimumab is another example of a TNF-alpha inhibitor, a wholly humanized antibody, and administered through a subcutaneous route.…”