Korean J Clin Pharm.  2015 Mar;25(1):9-17. 10.0000/kjcp.2015.25.1.9.

Comparative Effectiveness of Biologic DMARDs in Rheumatoid Arthritis Patients with Inadequate Response to conventional DMARDs: Using a Bayesian Network Meta-analysis

• Park SK
• Kim HL
• Lee MY
• Kim A
• Lee EK

• KMID: 2226396
• DOI: http://doi.org/10.0000/kjcp.2015.25.1.9

Abstract

BACKGROUND
Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacy compared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. The objective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab with conventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under the condition of the reimbursement coverage criteria in Korea.
METHODS
A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesian outcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR was greater than one.
RESULTS
Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR response rates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) for Golimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. In ACR50 and ACR70, the ORs did not present significant differences.
CONCLUSION
Certolizaumab with cDMARD was more effective or comparable than other bDMARDs in patients who failed prior cDMARD treatment.

Keyword

certolizumab; bayesian network meta-analysis; biologic disease-modifying antirheumatic drugs (bDMARDs); rheumatoid arthritis

MeSH Terms

Antirheumatic Agents*
Arthritis, Rheumatoid*
Humans
Korea
Odds Ratio
Rheumatology
Abatacept
Adalimumab
Infliximab
Rituximab
Etanercept
Antirheumatic Agents