A network meta-analysis of randomized controlled trials of biologics for rheumatoid arthritis: a Cochrane overview.
Abstract | BACKGROUND: METHODS: In this network meta-analysis, we included all completed and updated Cochrane reviews on biologics for rheumatoid arthritis. We included data from all placebo-controlled trials that used standard dosing regimens. The major outcomes were benefit (defined as a 50% improvement in patient- and physician-reported criteria of the American College of Rheumatology [ACR50]) and safety (determined by the number of withdrawals related to adverse events). We used mixed-effects logistic regression to carry out an indirect comparison of the treatment effects between biologics. RESULTS: Compared with placebo, biologics were associated with a clinically important higher ACR50 rate (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.62-4.29) and a number needed to treat for benefit of 4 (95% CI 4-6). However, biologics were associated with more withdrawals related to adverse events (OR 1.39, 95% CI 1.13-1.71), with a number needed to treat for harm of 52 (95% CI 29-152). Anakinra was less effective than all of the other biologics, although this difference was statistically significant only for the comparison with adalimumab (OR 0.45, 95% CI 0.21-0.99) and etanercept (OR 0.34, 95% CI 0.14-0.81). Adalimumab, anakinra and infliximab were more likely than etanercept to lead to withdrawals related to adverse events ( adalimumab OR 1.89, 95% CI 1.18-3.04; anakinra OR 2.05, 95% CI 1.27-3.29; and infliximab OR 2.70, 95% CI 1.43-5.26). INTERPRETATION:
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Authors | Jasvinder A Singh, Robin Christensen, George A Wells, Maria E Suarez-Almazor, Rachelle Buchbinder, Maria Angeles Lopez-Olivo, Elizabeth Tanjong Ghogomu, Peter Tugwell |
Journal | CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
(CMAJ)
Vol. 181
Issue 11
Pg. 787-96
(Nov 24 2009)
ISSN: 1488-2329 [Electronic] Canada |
PMID | 19884297
(Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antirheumatic Agents
- Immunoconjugates
- Immunoglobulin G
- Interleukin 1 Receptor Antagonist Protein
- Receptors, Tumor Necrosis Factor
- Rituximab
- Abatacept
- Infliximab
- Adalimumab
- Etanercept
- Methotrexate
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Topics |
- Abatacept
- Adalimumab
- Antibodies, Monoclonal
(adverse effects, therapeutic use)
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antirheumatic Agents
(adverse effects, therapeutic use)
- Arthritis, Rheumatoid
(drug therapy)
- Drug Therapy, Combination
- Etanercept
- Humans
- Immunoconjugates
(adverse effects, therapeutic use)
- Immunoglobulin G
(adverse effects, therapeutic use)
- Infliximab
- Interleukin 1 Receptor Antagonist Protein
(adverse effects, therapeutic use)
- Logistic Models
- Methotrexate
(therapeutic use)
- Odds Ratio
- Receptors, Tumor Necrosis Factor
(therapeutic use)
- Rituximab
- Treatment Outcome
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