Background Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease with articular and dermatological manifestations. PsA varies in severity and type of tissue involvement and may significantly impact patients’ function and quality of life.
Objectives To determine the relative effectiveness of UK licensed biological disease-modifying anti-rheumatic drugs (bDMARDs) for the treatment of active, progressive PsA in patients with inadequate response to previous DMARDs.
Methods A systematic review was conducted to identify relevant randomised controlled trials (RCTs) of bDMARDS. The main outcomes of interest included number of patients meeting Psoriatic Arthritis Response Criteria (PsARC) at follow-up and change in Health Assessment Questionnaire (HAQ) score from baseline conditional on PsARC response. Literature searches were conducted in relevant electronic databases and the grey literature. Data were extracted by two independent reviewers. A Bayesian network meta-analysis (NMA) was conducted in WinBUGs using a fixed and random-effects logit model fitted to the binomial data and an identity model for the continuous data.
Results 2,099 citations were identified and on reviewing full-text papers, 30 publications of 12 studies met the criteria for inclusion in the review. On review of the dataset, seven placebo-controlled studies of licensed bDMARDs were included in the NMA: two studies of adalimumab (ADA) 40 mg every other week (n=204) vs PLA (n=211); two studies of etanercept (ETN) 25 mg twice weekly (n=131) vs placebo (PLA) (n=134); one study of golimumab (GOL) 50 mg every 4 weeks (n=146) vs PLA (n=113) (plus unlicensed arm: not shown); and two studies of infliximab (IFX) 5 mg/kg (n=152) vs PLA (n=152). The table summarises the fixed-effect NMA results for PsARC, and change in HAQ (for all patients and conditional on PsARC response) based on 12 to 16 week follow-up data. Similar results were obtained with random-effects NMA and results were subject to a sensitivity analysis.
Conclusions In these selected studies, all bDMARDs were significantly more effective than placebo in achieving PsARC response in patients with active PsA. Of the studies included in the analysis, ADA, ETN and IFX were significantly more effective than placebo in improving HAQ scores in all patients regardless of PsARC response and in subgroups who achieved a PsARC response and PsARC non-responders.
Disclosure of Interest D. Spurden Employee of: Pfizer Ltd, M. Orme Consultant for: Pfizer Ltd, S. Mitchell Consultant for: Pfizer Ltd, A. Bird Employee of: Pfizer Ltd.