RESEARCH - Comparisons of the efficacy of biologic DMARDs in RA patients with inadequate responses

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Ann Rheum Dis. 2010 Nov 19.

Indirect comparisons of the efficacy of biological antirheumatic

agents in rheumatoid arthritis in patients with an inadequate response

to conventional disease-modifying antirheumatic drugs or to an

anti-tumour necrosis factor agent: a meta-analysis.

Salliot C, Finckh A, Katchamart W, Lu Y, Sun Y, Bombardier C, Keystone E.

1Division of Rheumatology, Mount Sinai Hospital, University of

Toronto, Toronto, Canada.

Abstract

BACKGROUND: The availability of increasing numbers of biological

agents for the treatment of rheumatoid arthritis (RA) offers several

therapeutic options. While all biologicals have proven effective in

trials, very limited direct comparisons are available. The objective

of the present work was to compare the efficacy of biologicals

(anti-tumour necrosis factor (TNF) agents, rituximab, abatacept,

tocilizumab) in patients with RA with active disease and (i) an

inadequate response (IR) to methotrexate (IR-MTX), (ii) an IR to

anti-TNF agents (IR-anti-TNFs) using indirect comparisons.

METHODS: Randomised clinical trials were identified examining the

efficacy of a biological agent in RA at 6 months in patients with an

IR-MTX or with an IR-anti-TNF. To compare the relative efficacy of

biologicals, adjusted indirect comparison meta-analytic methods to

estimate the ORs of achieving a 50% improvement according to American

College of Rheumatology criteria (ACR50) response at 6 months were

used.

RESULTS: A total of 18 published trials and 1 abstract were included

in the analyses. In IR-MTX, anti-TNFs had the same probability of

reaching an ACR50 compared to 'non-anti-TNF biologicals' taken

together (OR 1.30, 95 % CI 0.91 to 1.86). However, when compared to

specific biological agents, anti-TNFs demonstrated a higher

probability of reaching an ACR50 than abatacept (OR 1.52, 95 % CI 1.0

to 2.28), but not in comparison to rituximab and tocilizumab. In

IR-anti-TNF, rituximab demonstrated a higher probability of achieving

an ACR50 than tocilizumab (OR 2.61, 95% CI 1.10 to 6.37), but no

significant differences existed between golimumab and other

biologicals.

CONCLUSIONS: In a meta-analysis of randomised clinical trials of

patients with IR-MTX, anti-TNFs demonstrated a higher probability of

achieving an ACR50 response than abatacept. In IR-anti-TNF, rituximab

appears more likely than tocilizumab to achieve an ACR50 response.

PMID: 21097801

http://www.ncbi.nlm.nih.gov/pubmed/21097801

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