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Rheumatoid arthritis treated with 6-months of first-line biologic or biosimilar therapy: an updated systematic review and network meta-analysis

Published online by Cambridge University Press:  06 February 2019

Emma L. Simpson ,
Shijie Ren ,
Emma S. Hock Open the ORCID record for Emma S. Hock [Opens in a new window] ,
John W. Stevens ,
Aymeric Binard ,
Yves-Marie Pers ,
Rachel Archer ,
Suzy Paisley ,
Matthew D. Stevenson  and
Chloé Herpin
...Show all authors
Emma L. Simpson
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Shijie Ren
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Emma S. Hock
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
John W. Stevens
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Aymeric Binard
Affiliation:
Department of Rheumatology, CHU de la Cavale-Blanche, Brest, France
Yves-Marie Pers
Affiliation:
Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, France IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
Rachel Archer
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Suzy Paisley
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Matthew D. Stevenson
Affiliation:
School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
Chloé Herpin
Affiliation:
Department of Economic and Public Health Evaluation, French National Authority for Health (HAS), Saint-Denis La Plaine, France
Salah Ghabri*
Affiliation:
Department of Economic and Public Health Evaluation, French National Authority for Health (HAS), Saint-Denis La Plaine, France
*
Author for correspondence: Salah Ghabri, E-mail: s.ghabri@has-sante.fr
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Abstract

Objectives

The aim of this study was to estimate the effectiveness of first-line biologic disease modifying drugs(boDMARDs), and their approved biosimilars (bsDMARDs), compared with conventional (csDMARD) treatment, in terms of ACR (American College of Rheumatology) and EULAR (European League against Rheumatism) responses.

Methods

Systematic literature search, on eight databases to January 2017, sought ACR and EULAR data from randomized controlled trials (RCTs) of boDMARDs / bsDMARDs (in combination with csDMARDs, or monotherapy). Two adult populations: methotrexate (MTX)-naïve patients with severe active RA; and csDMARD-experienced patients with moderate-to-severe active RA. Network meta-analyses (NMA) were conducted using a Bayesian Markov chain Monte Carlo simulation using a random effects model with a probit link function for ordered categorical.

Results

Forty-six RCTs met the eligibility criteria. In the MTX-naïve severe active RA population, no biosimilar trials meeting the inclusion criteria were identified. MTX plus methylprednisolone (MP) was most likely to achieve the best ACR response. There was insufficient evidence that combination boDMARDs was superior to intensive (two or more) csDMARDs. In the csDMARD-experienced, moderate-to-severe RA population, the greatest effects for ACR responses were associated with tocilizumab (TCZ) monotherapy, and combination therapy (plus MTX) with bsDMARD etanercept (ETN) SB4, boDMARD ETN and TCZ. These treatments also had the greatest effects on EULAR responses. No clear differences were found between the boDMARDs and their bsDMARDs.

Conclusions

In MTX-naïve patients, there was insufficient evidence that combination boDMARDs was superior to two or more csDMARDs. In csDMARD-experienced patients, boDMARDs and bsDMARDs were comparable and all combination boDMARDs / bsDMARDs were superior to single csDMARD.

Keywords

Rheumatoid arthritisBiological agentsBiosimilarSystematic reviewNetwork meta-analysis
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 1 , 2019 , pp. 36 - 44
Copyright
Copyright © Cambridge University Press 2019 

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