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Meta-analysis of the Efficacy and Safety of Adalimumab, Etanercept,

and Infliximab for the Treatment of Rheumatoid Arthritis

Posted 14 Apr 2010

Pharmacotherapy. 2010;30(4):339-353. © 2010 Pharmacotherapy Publications

Astrid Wiens, M.S.; Venson, Pharm.D.; Cassyano J. Correr,

Ph.D.; Michel Fleith Otuki, Ph.D.; o Pontarolo, Ph.D.

Abstract

Study objective. To evaluate the efficacy and safety of using the

anti-tumor necrosis factor-á (anti-TNF-á) drugs adalimumab,

etanercept, and infliximab for the treatment of rheumatoid arthritis.

Design. Systematic review and meta-analysis of 21 randomized,

placebo-controlled trials (eight adalimumab, seven infliximab, six

etanercept).

Patients. Adults with rheumatoid arthritis who received adalimumab

(1524 patients), infliximab (1116 patients), etanercept (1029

patients), or placebo (2834 patients) with or without concomitant

methotrexate in all groups.

Measurements and main results. A literature search of several

databases from January 1995-December 2008 was performed. There were no

restrictions based on language or date of publication, and low-quality

studies (based on Jadad score) were excluded. American College of

Rheumatology (ACR) 20% improvement criteria (ACR20), 50% improvement

criteria (ACR50), and 70% improvement criteria (ACR70) were used to

compare treatment efficacy. Safety was compared based on frequency of

serious adverse events, serious infections, malignancy, and death.

Withdrawals due to adverse events and lack of efficacy were also

evaluated. With short-term treatment (12-30 wks), etanercept

demonstrated the highest risk ratios (RRs) for reaching ACR20 and

ACR50: 2.94 (95% confidence interval [CI] 2.27-3.81) and 5.28 (95% CI

3.12-8.92), respectively. Adalimumab demonstrated the highest RR for

achieving ACR70 (5.36, 95% CI 3.76- 7.64). Over a long-term treatment

course (1-3 yrs), adalimumab demonstrated the highest RRs (95% CIs)

for these parameters: 1.85 (1.07-3.19), 2.80 (1.16-6.77), and 3.23

(1.37-7.61) for ACR20, ACR50, and ACR70, respectively. No

statistically significant differences were noted in the safety of any

of the three drugs compared with placebo. Infliximab had the highest

RRs for withdrawing from the study due to lack of efficacy (2.05, 95%

CI 1.33-3.16) and adverse events (0.41, 95% CI 0.18-0.95).

Conclusion. With short-term treatment, etanercept and adalimumab had

higher efficacy results; with long-term treatment, adalimumab appeared

to be the most effective. Clinicians should be aware that each of the

three drugs has different rates of efficacy and different safety

considerations that must be taken into account when selecting the best

treatment for an individual with rheumatoid arthritis.

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Read the full article here:

http://www.medscape.com/viewarticle/719484

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