BACKGROUND: We sought to compare the benefits and safety of 6 biologics (abatacept, adalimumab, anakinra, etanercept, infliximab and rituximab) in patients with rheumatoid arthritis. METHODS: In this network meta-analysis, we included all completed and updated Cochrane reviews on biologics for rheumatoid arthritis. We included data from all placebo-controlled trials that used standard dosing regimens. The major outcomes were benefit (defined as a 50% improvement in patient- and physician-reported criteria of the American College of Rheumatology [ACR50]) and safety (determined by the number of withdrawals related to adverse events). We used mixed-effects logistic regression to carry out an indirect comparison of the treatment effects between biologics. RESULTS: Compared with placebo, biologics were associated with a clinically important higher ACR50 rate (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.62-4.29) and a number needed to treat for benefit of 4 (95% CI 4-6). However, biologics were associated with more withdrawals related to adverse events (OR 1.39, 95% CI 1.13-1.71), with a number needed to treat for harm of 52 (95% CI 29-152). Anakinra was less effective than all of the other biologics, although this difference was statistically significant only for the comparison with adalimumab (OR 0.45, 95% CI 0.21-0.99) and etanercept (OR 0.34, 95% CI 0.14-0.81). Adalimumab, anakinra and infliximab were more likely than etanercept to lead to withdrawals related to adverse events (adalimumab OR 1.89, 95% CI 1.18-3.04; anakinra OR 2.05, 95% CI 1.27-3.29; and infliximab OR 2.70, 95% CI 1.43-5.26). INTERPRETATION: Given the limitations of indirect comparisons, anakinra was less effective than adalimumab and etanercept, and etanercept was safer than adalimumab, anakinra and infliximab. This summary of the evidence will help physicians and patients to make evidence-based choices about biologics for the treatment of rheumatoid arthritis.
BACKGROUND: We sought to compare the benefits and safety of 6 biologics (abatacept, adalimumab, anakinra, etanercept, infliximab and rituximab) in patients with rheumatoid arthritis. METHODS: In this network meta-analysis, we included all completed and updated Cochrane reviews on biologics for rheumatoid arthritis. We included data from all placebo-controlled trials that used standard dosing regimens. The major outcomes were benefit (defined as a 50% improvement in patient- and physician-reported criteria of the American College of Rheumatology [ACR50]) and safety (determined by the number of withdrawals related to adverse events). We used mixed-effects logistic regression to carry out an indirect comparison of the treatment effects between biologics. RESULTS: Compared with placebo, biologics were associated with a clinically important higher ACR50 rate (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.62-4.29) and a number needed to treat for benefit of 4 (95% CI 4-6). However, biologics were associated with more withdrawals related to adverse events (OR 1.39, 95% CI 1.13-1.71), with a number needed to treat for harm of 52 (95% CI 29-152). Anakinra was less effective than all of the other biologics, although this difference was statistically significant only for the comparison with adalimumab (OR 0.45, 95% CI 0.21-0.99) and etanercept (OR 0.34, 95% CI 0.14-0.81). Adalimumab, anakinra and infliximab were more likely than etanercept to lead to withdrawals related to adverse events (adalimumab OR 1.89, 95% CI 1.18-3.04; anakinra OR 2.05, 95% CI 1.27-3.29; and infliximab OR 2.70, 95% CI 1.43-5.26). INTERPRETATION: Given the limitations of indirect comparisons, anakinra was less effective than adalimumab and etanercept, and etanercept was safer than adalimumab, anakinra and infliximab. This summary of the evidence will help physicians and patients to make evidence-based choices about biologics for the treatment of rheumatoid arthritis.
Authors: Paul Emery; Roy Fleischmann; Anna Filipowicz-Sosnowska; Joy Schechtman; Leszek Szczepanski; Arthur Kavanaugh; Artur J Racewicz; Ronald F van Vollenhoven; Nicole F Li; Sunil Agarwal; Eva W Hessey; Timothy M Shaw Journal: Arthritis Rheum Date: 2006-05
Authors: Joel M Kremer; Harry K Genant; Larry W Moreland; Anthony S Russell; Paul Emery; Carlos Abud-Mendoza; Jacek Szechinski; Tracy Li; Zhiyu Ge; Jean-Claude Becker; Rene Westhovens Journal: Ann Intern Med Date: 2006-06-20 Impact factor: 25.391
Authors: L W Moreland; M H Schiff; S W Baumgartner; E A Tindall; R M Fleischmann; K J Bulpitt; A L Weaver; E C Keystone; D E Furst; P J Mease; E M Ruderman; D A Horwitz; D G Arkfeld; L Garrison; D J Burge; C M Blosch; M L Lange; N D McDonnell; M E Weinblatt Journal: Ann Intern Med Date: 1999-03-16 Impact factor: 25.391
Authors: Ferdinand C Breedveld; Michael H Weisman; Arthur F Kavanaugh; Stanley B Cohen; Karel Pavelka; Ronald van Vollenhoven; John Sharp; John L Perez; George T Spencer-Green Journal: Arthritis Rheum Date: 2006-01
Authors: Mark A Quinn; Philip G Conaghan; Philip J O'Connor; Zunaid Karim; Adam Greenstein; Andrew Brown; Clare Brown; Alexander Fraser; Stephen Jarret; Paul Emery Journal: Arthritis Rheum Date: 2005-01
Authors: Young Ho Lee; Jin Hyun Woo; Young Hee Rho; Seong Jae Choi; Jong Dae Ji; Gwan Gyu Song Journal: Rheumatol Int Date: 2007-10-18 Impact factor: 2.631
Authors: Paul Emery; Ferdinand C Breedveld; Stephen Hall; Patrick Durez; David J Chang; Deborah Robertson; Amitabh Singh; Ronald D Pedersen; Andrew S Koenig; Bruce Freundlich Journal: Lancet Date: 2008-07-16 Impact factor: 79.321
Authors: Victoria Bejarano; Mark Quinn; Philip G Conaghan; Richard Reece; Anne-Maree Keenan; David Walker; Andrew Gough; Michael Green; Dennis McGonagle; Ade Adebajo; Stephen Jarrett; Sheelagh Doherty; Lesley Hordon; Richard Melsom; Kristina Unnebrink; Hartmut Kupper; Paul Emery Journal: Arthritis Rheum Date: 2008-10-15
Authors: Simon Tarp; Gil Amarilyo; Ivan Foeldvari; Robin Christensen; Jennifer M P Woo; Neta Cohen; Tracy D Pope; Daniel E Furst Journal: Rheumatology (Oxford) Date: 2015-11-30 Impact factor: 7.580