Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Singh, Jasvinder A; Christensen, Robin; Wells, George; Suarez‐Almazor, María E.; Buchbinder, Rachelle; Lopez-Olivo, Maria de los Angeles; Ghogomu, Elizabeth Tanjong; Tugwell, Peter

doi:10.1590/s1516-31802010000500013

Cited by 76 publications

(39 citation statements)

References 3 publications

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“…); on the cost-effectiveness of the treatment; and, especially, on the consensus that has been reached with the patient, after extensive discussion about the possible benefits, side effects and risks from the treatment. 1,2 …”

Section: Commentsmentioning

confidence: 99%

Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Singh

Christensen

Wells

et al. 2009

Cochrane Database of Systematic Reviews

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193

100

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BACKGROUND:The biologic disease-modifying anti-rheumatic drugs (DMARDs) are very effective in treating rheumatoid arthritis (RA), however there is a lack of head-to-head comparison studies.OBJECTIVES: To compare the efficacy and safety of abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab in patients with RA.METHODS: This 'Overview of Reviews' was done by including all Cochrane Reviews on Biologics for RA available in The Cochrane Library. We included only data on standard dosing regimens for these biologic DMARDs from placebo-controlled trials. The primary efficacy and safety outcomes were ACR50 and withdrawals due to adverse events. We calculated Risk Ratios (RR) for efficacy, Odds Ratio (OR) for safety and combined estimates of events across the placebo groups as the expected Control Event Rate (CER). Indirect comparisons of biologics were performed for efficacy and safety using a hierarchical linear mixed model incorporating the most important study level characteristic (i.e. type of biologic) as a fixed factor and study as a random factor; reducing the between study heterogeneity by adjusting for the interaction between the proportion of patients responding on placebo and the duration of the trial.MAIN RESULTS: From the six available Cochrane reviews, we obtained data from seven studies on abatacept, eight on adalimumab, five on anakinra, four on etanercept, four on infliximab, and three on rituximab. The indirect comparison estimates showed similar efficacy for the primary efficacy outcome for all biologics with three exceptions. Anakinra was less efficacious than etanercept with a ratio of RRs (95% CI; P value) of 0.44 (0.23 to 0.85; P = 0.014); anakinra was less efficacious than rituximab, 0.45 (0.22 to 0.90; P = 0.023); and likewise adalimumab was more efficacious than anakinra, 2.34 (1.32 to 4.13; P = 0.003). In terms of safety, adalimumab was more likely to lead to withdrawals compared to etanercept, with a ratio of ORs of 1.89 (1.18 to 3.04; P = 0.009); anakinra more likely than etanercept, 2.05 (1.27 to 3.29; P = 0.003); and likewise etanercept less likely than infliximab, 0.37 (0.19 to 0.70; P = 0.002).AUTHORS' CONCLUSIONS: Based upon indirect comparisons, anakinra seemed less efficacious than etanercept, adalimumab and rituximab and etanercept seemed to cause fewer withdrawals due to adverse events than adalimumab, anakinra and infliximab. Significant heterogeneity in characteristics of trial populations imply that these finding must be interpreted.

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Section: Commentsmentioning

confidence: 99%

Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Singh

Christensen

Wells

et al. 2009

Cochrane Database of Systematic Reviews

Self Cite

193

100

View full text Add to dashboard Cite

show abstract

“…The effectiveness of DMARDs and biological therapeutics on decreasing disease activity has been established. [2,3] Patients experience life with RA along a continuum from RA in the background to RA in the foreground of their lives, and vice versa. Even if RA is put back to the background of patient's lives by means of disease-modifying agents, most patients still experience continuous, daily symptoms.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an integrated care intervention on supervisor support and work functioning of workers with rheumatoid arthritis

Vilsteren¹,

Boot²,

Twisk³

et al. 2016

Disability and Rehabilitation

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“…Treatment options for RA include nonsteroidal antiinflammatory drugs, glucocorticoids, traditional diseasemodifying antirheumatic drugs (DMARDs), and biologic DMARDs (4). Biologic DMARDs are very effective in treating RA and are commonly used for patients with suboptimal response or intolerance to traditional DMARDs (4).…”

Section: Introductionmentioning

confidence: 99%

“…Biologic DMARDs are very effective in treating RA and are commonly used for patients with suboptimal response or intolerance to traditional DMARDs (4).…”

Section: Introductionmentioning

confidence: 99%

Patients' Willingness to Trade Off Between the Duration and Frequency of Rheumatoid Arthritis Treatments

Poulos

Hauber

González

et al. 2014

Arthritis Care & Research

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Objective. Biologic treatments for rheumatoid arthritis (RA) vary widely in both the time required to administer treatment and treatment frequency. This study aimed to quantify the rate at which RA patients are willing to trade off between the time required to administer treatment (duration) and treatment frequency. Methods. Respondents with a self-reported physician diagnosis of moderate to severe RA completed an online discrete choice experiment survey (also known as conjoint analysis). Respondents were presented with a series of treatmentchoice questions. Each hypothetical treatment included 6 attributes: response rate, mode of administration, treatment duration, treatment frequency, and the risks of immediate mild and serious treatment reactions. Preference weights, also called marginal utilities or relative importances, were estimated using mixed-logit methods and then used to calculate the marginal rates of substitution between attributes, including treatment duration and treatment frequency. Results. Among the 901 respondents, 505 were in the RA Information, Service, and Education group (www.risesupport. com) and 396 were members of an online panel. The marginal utility of changes in treatment features was largest for a 1-hour change in treatment duration, while a 1-unit change in the annual frequency of treatment was the second least important change. The marginal utility of changes in annual treatment frequency depends on the treatment duration and vice versa. Conclusion. Respondents would accept treatments with lower efficacy and greater risk to achieve lower duration and frequency. Previous studies have linked patient preferences to treatment adherence, suggesting that reductions in duration or frequency could improve adherence and health outcomes.

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Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Cited by 76 publications

References 3 publications

Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Biologics for rheumatoid arthritis: an overview of Cochrane reviews

Effectiveness of an integrated care intervention on supervisor support and work functioning of workers with rheumatoid arthritis

Patients' Willingness to Trade Off Between the Duration and Frequency of Rheumatoid Arthritis Treatments

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