PMID- 22294630
OWN - NLM
STAT- MEDLINE
DCOM- 20120925
LR  - 20181201
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 71
IP  - 8
DP  - 2012 Aug
TI  - Comparative effectiveness and safety of biological treatment options after tumour 
      necrosis factor alpha inhibitor failure in rheumatoid arthritis: systematic review 
      and indirect pairwise meta-analysis.
PG  - 1303-8
LID - 10.1136/annrheumdis-2011-200490 [doi]
AB  - BACKGROUND: Optimal treatment for rheumatoid arthritis (RA) after inadequate 
      response (IR) to tumour necrosis factor alpha inhibitors (TNFi) remains uncertain. 
      OBJECTIVE: To compare the efficacy and safety of biological agents after TNFi-IR. 
      METHODS: A systematic literature search was carried out using Medline and 
      Cochrane databases, as well as http://www.clinicaltrials.gov, and bibliographies 
      of the retrieved literature were searched by hand. Randomised, placebo-controlled 
      trials that enrolled patients with RA with TNFi-IR were included and American 
      College of Rheumatology (ACR) response as primary efficacy outcome and adverse 
      events (AEs), serious adverse events (SAEs) and serious infections (SIs) as 
      safety measures were extracted. An indirect meta-analysis with pairwise 
      comparisons of efficacy and safety data was then carried out using ORs or risk 
      differences (RDs) in a random effects model. RESULTS: In four randomised 
      controlled trials with 24 weeks' follow-up, direct comparisons of abatacept, 
      golimumab, rituximab and tocilizumab versus placebo showed statistically 
      significant mean ORs of 3.3-8.9 for ACR20, 5.5-10.2 for ACR50 and 4.1-13.5 for 
      ACR70. Risks of AEs, SAEs and SIs versus placebo were non-significant. Indirect 
      pairwise comparisons of the four biological agents showed no significant 
      differences in ACR50 and ACR70. Golimumab had a significantly lower OR 
      (0.56-0.59) for ACR20 but significantly fewer AEs (RD 0.13-0.18). Efficacy after 
      one versus multiple TNFi failures did not differ significantly between the 
      different biological agents. CONCLUSION: In patients refractory to one or more 
      TNFi, new biological agents provide significant improvement with good safety. 
      Lacking head-to-head trials, indirect meta-analysis enables a comparison of 
      effectiveness and safety of biological agents with each other and shows that all 
      biological agents have similar effects.
FAU - Schoels, Monika
AU  - Schoels M
AD  - 2nd Department of Internal Medicine, Hietzing Hospital, Vienna, Austria. 
      monika.schoels@chello.at
FAU - Aletaha, Daniel
AU  - Aletaha D
FAU - Smolen, Josef S
AU  - Smolen JS
FAU - Wong, John B
AU  - Wong JB
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20120130
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Immunoconjugates)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 7D0YB67S97 (Abatacept)
RN  - 91X1KLU43E (golimumab)
RN  - I031V2H011 (tocilizumab)
SB  - IM
MH  - Abatacept
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Antibodies, Monoclonal, Humanized/therapeutic use
MH  - Antibodies, Monoclonal, Murine-Derived/therapeutic use
MH  - Antirheumatic Agents/*therapeutic use
MH  - Drug Substitution
MH  - Female
MH  - Humans
MH  - Immunoconjugates/therapeutic use
MH  - MEDLINE
MH  - Male
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Rheumatic Fever/*drug therapy
MH  - Rituximab
MH  - Treatment Failure
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors
EDAT- 2012/02/02 06:00
MHDA- 2012/09/26 06:00
CRDT- 2012/02/02 06:00
PHST- 2012/02/02 06:00 [entrez]
PHST- 2012/02/02 06:00 [pubmed]
PHST- 2012/09/26 06:00 [medline]
AID - annrheumdis-2011-200490 [pii]
AID - 10.1136/annrheumdis-2011-200490 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2012 Aug;71(8):1303-8. doi: 10.1136/annrheumdis-2011-200490. Epub 
      2012 Jan 30.