Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that, if inadequately treated, often progresses to joint destruction. Currently, patients are initially treated with conventional disease- modifying anti-rheumatic drugs (DMARDs); in patients with an inadequate response (IR), biologic DMARDs are often combined with methotrexate (MTX) or other DMARDs to improve efficacy.
Objectives To compare the relative efficacy and safety of abatacept versus all relevant biologic DMARDs in MTX-IR patients with RA.
Methods A systematic literature review identified randomised controlled trials (RCTs) investigating the efficacy and safety of abatacept subcutaneous (sc) and intravenous (iv), adalimumab, certolizumab, etanercept, infliximab, golimumab, tocilizumab and tofacitinib, in combination with MTX. The efficacy endpoints were American College of Rheumatology (ACR) 20/50/70 response rates and disease activity score 28 joints (DAS28) remission rates (DAS28≤2.6). Safety endpoints were incidence of serious adverse events (AE), infections, and serious infections. Abatacept sc and iv were compared to tocilizumab and the combined group of anti-TNFs (adalimumab, certolizumab, etanercept, infliximab, golimumab). Results were analysed with Bayesian hierarchical network meta-analysis (NMA) models to estimate the relative efficacy and safety effects of the biologic DMARDs. Although tofacitinib RCTS were identified in the systematic literature search, they were not included in the NMA because the study population of the three tofacitinib RCTs was different than that of the other RCTs; the majority of the patients in the tofacitinib RCTs were previously exposed to biologic DMARDs, while the patients in the other RCTs were naive to biologic DMARDs.
Results The search was performed in October 2013. A total of 21 RCTs were included. Results indicate that abatacept sc has similar ACR20/50/70 response rates and DAS28 remission rates compared to other biologic DMARDs after 24 weeks of treatment (Table 1). Similar efficacy results were found for abatacept iv (data not shown). Abatacept sc seems to have slightly better safety in comparison to tocilizumab and the combined anti-TNFs in terms of incidence of infections, serious infections, and serious AE (Table 1); however, none of these differences were statistically significant. Similar results were found when comparing abatacept iv with tocilizumab and the combined anti-TNFs (data not shown).
Conclusions Both abatacept sc and iv showed similar ACR20/50/70 and DAS28 remission rates compared to other biologic DMARDs in MTX-IR patients. Although not statistically significant, abatacept iv and sc tended to have slightly better safety outcomes as compared to other biologic DMARDs.
Disclosure of Interest M. Hochberg Grant/research support: NIH, Consultant for: BMS, Eli Lilly Co., EMD Serono Inc., Genentech/Roche, Novartis Pharma AG, Pfizer Inc, UCB Inc., K. Janssen Consultant for: Bristol-Myers Squibb., Employee of: Mapi Group, K. Broglio Consultant for: Bristol-Myers Squibb, Employee of: Berry Consultants, A. Walsem Consultant for: Bristol-Myers Squibb, Employee of: Mapi Group, A. Nadkarni Employee of: Employee and stockholder of BMS