Mixed treatment comparison of efficacy and tolerability of biologic agents in patients with rheumatoid arthritis.
Abstract Objective: To determine the comparative efficacy and tolerability of abatacept and tumor necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA) and inadequate response to conventional disease modifying anti-rheumatic drugs (DMARDs). Research design and methods: A syste...
| Publicado en: | Current Medical Research & Opinion Vol. 29; no. 10; pp. 1213 - 1223 |
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| Autores principales: | , , , , , , |
| Formato: | research systematic review Journal Article |
| Publicado: |
Taylor & Francis Ltd
Oct2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104096825&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104096825 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03007995 DFY jtl: Current Medical Research & Opinion issn: 03007995 maglogo: N pubinfo: dt: Oct2013 vid: 29 iid: 10 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 104096825 2012303057 10.1185/03007995.2013.813839 NLM23745516 104096825 ppf: 1213 ppct: 10 formats: tig: atl: Mixed treatment comparison of efficacy and tolerability of biologic agents in patients with rheumatoid arthritis. aug: au: Hochberg, Marc C Berry, Scott Broglio, Kristine Rosenblatt, Lisa Nadkarni, Anagha Trivedi, Digisha Hebden, Tony affil: University of Maryland School of Medicine , Baltimore, MD , USA. sug: subj: Antirheumatic Agents Therapeutic Use Arthritis, Rheumatoid Drug Therapy Models, Biological Tumor Necrosis Factor Antagonists and Inhibitors Antirheumatic Agents Adverse Effects Arthritis, Rheumatoid Metabolism Arthritis, Rheumatoid Pathology Arthritis, Rheumatoid Physiopathology Female Human Male Probability Systematic Review Female Male ab: Abstract Objective: To determine the comparative efficacy and tolerability of abatacept and tumor necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA) and inadequate response to conventional disease modifying anti-rheumatic drugs (DMARDs). Research design and methods: A systematic review identified RCTs in RA patients who responded inadequately to conventional DMARDs and were treated with one of the following biologic agents: abatacept, adalimumab, etanercept, infliximab, certolizumab pegol, or golimumab. Bayesian hierarchical models were used to compare efficacy and tolerability outcomes of abatacept and combined TNFi at 6 months and 1 year. Results: In this mixed treatment comparison (MTC), the likelihood of achieving ACR response was comparable between abatacept and combined TNFi at 6 months for ACR20, 50, and 70: (odds ratio [OR] = 0.98 [95% confidence interval (CI): 0.73, 1.27], 0.99 [0.73, 1.31], and 0.91 [0.62, 1.27], respectively); and at 12 months for ACR20 (OR = 1.27 [0.92, 1.71]) and ACR50 (1.21 [0.82, 1.68]), with a higher likelihood of achieving an ACR70 response at 12 months (1.41 [1.02, 1.82]). Odds of DAS28 remission at 12 months was greater for abatacept than the combined TNFi (OR = 2.03 [1.04, 3.58]). Abatacept had better tolerability, defined as a lower likelihood of withdrawal due to adverse events, at both 6 and 12 months (OR = 0.38 [0.10, 0.88] and 0.51 [0.27, 0.86], respectively). These analyses include indirect comparisons across clinical trials and are not a replacement for head-to-head data. While all TNFi have been grouped into one class, there may be some differences between the individual TNFi that are not captured in our study. Conclusions: In this MTC, abatacept demonstrated similar efficacy at 6 months, a higher likelihood of achieving ACR70 response and DAS28 remission at 12 months and better tolerability relative to the combined TNFi in patients with RA who had an inadequate response to conventional DMARDs. pubtype: Academic Journal doctype: research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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