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Biologic Rheumatoid Arthritis Therapies

Do We Need More Comparative Effectiveness Data?

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Abstract

Rheumatoid arthritis (RA) affects an estimated 1.3 million Americans and is a complex inflammatory disease associated with synovitis and joint destruction. The development of biologic disease-modifying anti-rheumatic drugs (DMARDs) that target specific mediators of inflammation has led to several highly successful therapies for the treatment of RA. The imperfect efficacy of biologic DMARDs has resulted in the absence of clear guidelines on how biologic DMARDs should be used in the clinic to optimize treatment of RA patients. This makes it imperative that better data be available to physicians and RA patients about the comparative effectiveness of different biologic DMARDs. Prior to 2008, there were no randomized trials comparing biologic DMARDs for the treatment of RA. Since then, there have been published studies that directly compared biologic DMARDs for the treatment of RA, and several studies that estimated the relative efficacy of different biologic DMARDs by comparing published results of studies that included treatment of RA patients with biologic DMARDs who had previously experienced an inadequate response to methotrexate or tumor necrosis factor (TNF) antagonists. There are two recent studies that directly compared biologic DMARDs with optimal combinations of oral DMARDs and these are important because there are significant differences in costs and side effects between oral and biologic DMARDs. Among the studies that directly compared biologic DMARDs, it has been reported that RA patients who fail a TNF antagonist have a higher response rate (based on disease activity score [DAS28] measurements) to treatment with rituximab as compared with another TNF antagonist. In addition, in the ATTEST trial, the investigators found that, for RA patients with an inadequate response to methotrexate, treatment with abatacept versus infliximab resulted in response rates that were roughly equal. There are also several head-to-head studies of biologic DMARDs that are currently enrolling or about to enroll RA subjects. Pharmaceutical companies have taken more interest in comparative effectiveness studies, in part due to the emphasis that has been placed on this type of research by the US federal government and associated organizations including the Patient-Centered Outcomes Research Institute (PCORI). Therefore, while there is currently a relative lack of comparative effectiveness research to inform clinical decisions about biologic DMARDs for RA patients, it appears likely that there will be wider availability of such data in the near future.

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References

  1. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008; 58 (1): 15–25

    Article  Google Scholar 

  2. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet 2001; 358 (9285): 903–11

    Article  PubMed  CAS  Google Scholar 

  3. Smolen JS, Aletaha D, Koeller M, et al. New therapies for treatment of rheumatoid arthritis. Lancet 2007; 370 (9602): 1861–74

    Article  PubMed  CAS  Google Scholar 

  4. Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthritis Rheum 2001; 44 (12): 2746–9

    Article  PubMed  CAS  Google Scholar 

  5. Lundkvist J, Kastang F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ 2008; 8 Suppl. 2: S49–60

    Article  PubMed  Google Scholar 

  6. Currie CJ, McEwan P, Peters JR, et al. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects. Value Health 2005; 8 (5): 581–90

    Article  PubMed  Google Scholar 

  7. Allaire S, Wolfe F, Niu J, et al. Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US. Arthritis Rheum 2008; 59 (4): 474–80

    Article  PubMed  Google Scholar 

  8. Toussirot E, Wendling D. The use of TNF-alpha blocking agents in rheumatoid arthritis: an update. Expert Opin Pharmacother 2007; 8 (13): 2089–107

    Article  PubMed  CAS  Google Scholar 

  9. IOM. Institute of Medicine (IOM) report on national priorities for clinical research, 2009 [online]. Available from URL: www.nap.edu/catalog/12648.html [Accessed 2012 Feb 14]

  10. Sox HC, Greenfield S. Comparative effectiveness research: a report from the Institute of Medicine. Ann Intern Med 2009; 151 (3): 203–5

    Article  PubMed  Google Scholar 

  11. Sox HC. Comparative effectiveness research: a progress report. Ann Intern Med 2010; 153 (7): 469–72

    Article  PubMed  Google Scholar 

  12. O’Dell JR, Mikuls TR, Colbert RA, et al. American College of Rheumatology Clinical Trial Priorities and Design Conference, July 22–23, 2010. Arthritis Rheum 2011; 63 (8): 2151–6

    Article  Google Scholar 

  13. Wolfe F, Michaud K, Pincus T. Do rheumatology cost-effectiveness analyses make sense? Rheumatology 2004; 43 (1): 4–6

    Article  PubMed  CAS  Google Scholar 

  14. Van den Hout WB. Deficiencies in current evaluations of the cost-effectiveness of biologic agents for RA. Nat Clin Pract Rheumatol 2009; 5: 78–9

    Article  PubMed  Google Scholar 

  15. Drummond MF, Barbieri M, Wong JB. Analytic choices in economic models of treatments for rheumatoid arthritis: What makes a difference? Med Decis Making 2005; 25 (5): 520–33

    Article  PubMed  CAS  Google Scholar 

  16. Donahue KE, Gartlehner G, Jonas DE, et al. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med 2008; 148 (2): 124–34

    Article  PubMed  Google Scholar 

  17. Siegel J. Comparative effectiveness of treatments for rheumatoid arthritis. Ann Intern Med 2008; 148 (2): 162–3

    Article  PubMed  Google Scholar 

  18. Gartlehner G, Hansen RA, Jonas BL, et al. The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: a systematic review and metaanalysis. J Rheumatol 2006; 33 (12): 2398–408

    PubMed  CAS  Google Scholar 

  19. Clark W, Jobanputra P, Barton P, et al. The clinical and cost-effectiveness of anakinra for the treatment of rheumatoid arthritis in adults: a systematic review and economic analysis. Health Technol Assess 2004; 8 (18): iii–iv, ix-x, 1-105

    PubMed  CAS  Google Scholar 

  20. Kristensen LE, Saxne T, Geborek P. The LUNDEX, a new index of drug efficacy in clinical practice: results of a five-year observational study of treatment with infliximab and etanercept among rheumatoid arthritis patients in southern Sweden. Arthritis Rheum 2006; 54 (2): 600–6

    Article  PubMed  CAS  Google Scholar 

  21. Geborek P, Crnkic M, Petersson IF, et al. Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden. Ann Rheum Dis 2002; 61 (9): 793–8

    Article  PubMed  CAS  Google Scholar 

  22. Weaver AL, Lautzenheiser RL, Schiff MH, et al. Real-world effectiveness of select biologic and DMARD monotherapy and combination therapy in the treatment of rheumatoid arthritis: results from the RADIUS observational registry. Curr Med Res Opin 2006; 22 (1): 185–98

    Article  PubMed  CAS  Google Scholar 

  23. Hochberg MC, Tracy JK, Hawkins-Holt M, et al. Comparison of the efficacy of the tumour necrosis factor alpha blocking agents adalimumab, etanercept, and infliximab when added to methotrexate in patients with active rheumatoid arthritis. Ann Rheum Dis 2003; 62 Suppl. 2: ii13–6

    PubMed  CAS  Google Scholar 

  24. Venkateshan SP, Sidhu S, Malhotra S, et al. Efficacy of biologicals in the treatment of rheumatoid arthritis. a meta-analysis. Pharmacology 2009; 83 (1): 1–9

    Article  PubMed  CAS  Google Scholar 

  25. Bergman GJ, Hochberg MC, Boers M, et al. Indirect comparison of tocilizumab and other biologic agents in patients with rheumatoid arthritis and inadequate response to disease-modifying antirheumatic drugs. Semin Arthritis Rheum 2010; 39 (6): 425–41

    Article  PubMed  CAS  Google Scholar 

  26. Devine EB, Alfonso-Cristancho R, Sullivan SD. Effectiveness of biologic therapies for rheumatoid arthritis: an indirect comparisons approach. Pharmacotherapy 2011; 31 (1): 39–51

    Article  PubMed  CAS  Google Scholar 

  27. Salliot C, Finckh A, Katchamart W, et al. Indirect comparisons of the efficacy of biological antirheumatic agents in rheumatoid arthritis in patients with an inadequate response to conventional disease-modifying antirheumatic drugs or to an anti-tumour necrosis factor agent: a meta-analysis. Ann Rheum Dis 2011; 70 (2): 266–71

    Article  PubMed  CAS  Google Scholar 

  28. Gallego-Galisteo M, Villa-Rubio A, Alegre-Del Rey E, et al. Indirect comparison of biological treatments in refractory rheumatoid arthritis. J Clin Pharm Ther 2011; 2011 (10): 1365–2710

    Google Scholar 

  29. van Vollenhoven RF, Ernestam S, Geborek P, et al. Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial. Lancet 2009; 374: 459–66

    Article  PubMed  Google Scholar 

  30. Moreland LW, O’Dell JR, Paulus HE, et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early, aggressive rheumatoid arthritis. Arthritis Rheum. In press

  31. Finckh A, Ciurea A, Brulhart L, et al. B cell depletion may be more effective than switching to an alternative anti-tumor necrosis factor agent in rheumatoid arthritis patients with inadequate response to anti-tumor necrosis factor agents. Arthritis Rheum 2007; 56 (5): 1417–23

    Article  PubMed  Google Scholar 

  32. Rubbert-Roth A, Finckh A. Treatment options in patients with rheumatoid arthritis failing initial TNF inhibitor therapy: a critical review. Arthritis Res Ther 2009; 11 Suppl. 1: S1

    Article  PubMed  Google Scholar 

  33. Schiff M, Keiserman M, Codding C, et al. Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate. Ann Rheum Dis 2008; 67 (8): 1096–103

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments and Disclosures

Dr. Levesque has been paid as a consultant by UCB and Genentech. Dr. Levesque receives research grant support from Genentech and has received grants for development of CME programs from UCB and Genentech. Dr. Levesque has been paid as an expert witness by Abbott Laboratories.

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Correspondence to Marc C. Levesque MD,PhD.

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Levesque, M.C. Biologic Rheumatoid Arthritis Therapies. BioDrugs 26, 65–70 (2012). https://doi.org/10.2165/11631320-000000000-00000

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