Background Direct head-to-head comparisons among all available biologic agents for efficacy on damage progression in rheumatoid arthritis (RA) have not been conducted.

Objectives To indirectly compare the 12 months effects of available biologic agents in slowing RA radiographic progression.

Methods A systematic review of literature of randomised, double-blind, controlled trials (RCTs) evaluating RA radiographic progression as a primary or secondary endpoint was conducted from Jan 1995 to May 2012. Radiographic progression from baseline, heterogeneity, and effect size (ES [95% CI]) were calculated through a mixed-effect model. Treatment with methotrexate (MTX-experienced or MTX-naïve) before study enrollment and period of study enrolment (PoE) were used as moderators.

Results The PubMed search resulted in 183 references and 14 were eligible for the meta-analysis (the first in 2000, the last in 2011). The analysis of study distribution in ES forest plots showed in both subgroups a high correlation between the study PoE and the impact of biological therapy (figure). In MTX-naïve subgroup, ES was statistically lower for infliximab compared with etanercept (P=0.003), abatacept (P<0.001), rituximab (P=0.001), and golimumab (P=0.023). In the MTX-experienced subgroup, ES was statistically lower for infliximab and etanercept versus abatacept (P<0.001 both) and golimumab (P<0.001 and P=0.018, respectively), and for adalimumab versus abatacept (P<0.001).

Conclusions PoE deeply influences study population propensity to radiographic progression in each trial. This finding does not allow the indirect comparison of various biologic agents, despite our mixed-model significantly reduces heterogeneity among RCTs.

References

1. Rahman MU. Ann Rheum Dis 2011;70:1631–40

Disclosure of Interest None Declared