Rheumatoid arthritisIndirect Comparison of Tocilizumab and Other Biologic Agents in Patients with Rheumatoid Arthritis and Inadequate Response to Disease-Modifying Antirheumatic Drugs
Section snippets
Identification of Eligible Studies and Data Extraction
A systematic literature search was performed to identify published results of RCTs that evaluated commonly used biologic agents licensed to treat patients with RA (adalimumab, etanercept, infliximab, abatacept, or rituximab). Anakinra, an IL-1 inhibitor, was excluded because of low frequency of use. MEDLINE and EMBASE databases were searched simultaneously using DataStar. Search terms included a combination of free-text and thesaurus terms relevant to RA agents. During the search period 1990
Identified Studies
The search strategy identified 714 potentially relevant studies. Of these, 650 studies did not meet inclusion criteria, primarily because they were not RCTs. After full text review and data extraction, 49 of the remaining 64 studies were excluded for reasons including absence of an ACR response measure, dose-ranging focus, and focus on a non–DMARD-IR population. Finally, after identifying 15 studies as candidates for inclusion, 3 studies of tocilizumab were added—2 in MTX-IR and 1 in DMARD-IR
Discussion
This meta-analysis suggests the efficacy of tocilizumab is at least as good as that of other biologics and may be even better. In particular, the overall response pattern of tocilizumab differed from that of other biologics: it was similar in ACR20/50 responses but better in ACR70 responses. Although this was an analysis of efficacy, it is important to note that both short-term safety data from the clinical studies and longer term data from the extension studies support a favorable benefit-risk
Acknowledgment
We thank Cathy R. Winter, PhD, of ApotheCom (Yardley, PA) for editorial assistance.
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2019, Journal of Clinical EpidemiologyCitation Excerpt :Data sets that originally used extensions of the classical NMA model (e.g., models for competing-risk outcomes and evidence inconsistency) were excluded [38]. In addition, we excluded 5 NMAs that addressed similar questions and had overlapping studies [40–44]. Finally, we obtained 40 NMAs which evaluated a variety of conditions with important morbidity, including rheumatoid arthritis, stroke, cancer, chronic hepatitis B infection, depressive disorder, vertebral fractures, major cardiovascular events, etc.
Defining the optimal biological monotherapy in rheumatoid arthritis: A systematic review and meta-analysis of randomised trials
2017, Seminars in Arthritis and RheumatismCitation Excerpt :As biological agents have shown more favorable response in combination with csDMARD therapy (primarily MTX) [9] combination treatment strategies should be applied when possible [4]. As many RA patients might not adhere to their csDMARD prescription (e.g., intolerance), it is important to evaluate the benefit and harm associated with use of biological agents as monotherapy, and not only the traditional combination therapy strategies [10–12]. The objective of this study was to assess the efficacy and safety of the individual biological agents used in monotherapy in patients with RA to inform decision makers on the relative effectiveness of biological agents used in monotherapy for patients where csDMARD therapy is inappropriate.
Tofacitinib Versus Biologic Treatments in Patients With Active Rheumatoid Arthritis Who Have Had an Inadequate Response to Tumor Necrosis Factor Inhibitors: Results From a Network Meta-analysis
2016, Clinical TherapeuticsCitation Excerpt :Network meta-analyses are an accepted technique used to combine results of multiple RCTs, to allow treatment comparisons not directly made within trials. In recent years, several network meta-analyses of bDMARD treatments for RA have been published, including an analysis of TNFi-IR patients,22 and give comparable findings despite differences in methodology.22,35-40 However, when conducting network meta-analyses, randomization only holds within each trial, not across trials; therefore, only relative treatment effects can be assessed.
This study was funded by Hoffmann La-Roche.
Neil Wintfeld and Adrian Kielhorn are employees of Hoffmann La-Roche. Gert J. D. Bergman and Jeroen P. Jansen are employees of Mapi Values. Mapi Values received fees to perform the analysis. Marc Hochberg is a consultant to or a member of an advisory board for Abbott, Amgen, Bristol-Myers Squibb, Hoffman La-Roche, and UCB, Inc. Maarten Boers is a consultant for GlaxoSmithKline, Sanofi, Genentech, Hoffmann La-Roche, MedImmune, Novartis, Schering-Plough, AstraZeneca, Nitec, NicOx, Savient, Combinatorx, Merck Serono, Augurex, and Mapi Values.