RESEARCH - Effectiveness of anti-TNF biologics when used sequentially in RA

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Rheumatology Advance Access published online on June 21, 2010

Rheumatology, doi:10.1093/rheumatology/keq169

The effectiveness of anti-TNF- therapies when used sequentially in

rheumatoid arthritis patients: a systematic review and meta-analysis

Suzanne Lloyd1,*, Sylwia Bujkiewicz1,*, Allan J. Wailoo2, J.

Sutton1 and 3

1Department of Health Sciences, University of Leicester, Leicester,

2Health Economics and Decision Science, School of Health and Related

Research, University of Sheffield, Sheffield and 3Department of

Rheumatology, King’s College London, London, UK.

Abstract

Objectives.

To systematically review and meta-analyse evidence on the

effectiveness of the TNF- inhibitors when used sequentially.

Methods.

Systematic review of comparative and single-arm observational studies.

Data were synthesized using random-effects meta-analysis. Treatment

effects were estimated using four outcome measures from the included

studies: European League Against Rheumatism (EULAR) and ACR20 response

rates and mean improvement in disease activity score-28 (DAS-20) and

HAQ. The effect of other factors was explored via meta-regression and

sub-group analyses.

Results.

Twenty studies comprising 2705 patients were included in the analysis.

All studies were observational and most had no control group.

Therefore, our primary analysis considered patient changes from

baseline. The mean percentage of ACR20 responders was 60.8% (95% CI

53.8, 67.4), EULAR responders 70.5% (95% CI 63.7, 76.6), mean overall

improvement in DAS-28 scores was 1.53 (95% CI 1.25, 1.80) and in HAQ

scores was 0.25 (95% CI 0.11, 0.40). Four studies made comparisons

with patients who received TNF- inhibitors for the first time.

Response rates associated with sequential TNF- inhibitor treatment

were lower than for first-time use.

Conclusions.

Sequential TNF- inhibitor use is likely to lead to treatment benefit

in terms of the signs and symptoms of disease and physical function.

There is also some evidence to suggest that the probability of

achieving a response is lower, and the average magnitude of response

is lower than the first use. Further evidence from randomized

controlled trials is required to confirm and further quantify the role

specific anti-TNF- agents have when used sequentially.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/keq169v1?papetoc

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