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Aceves-Ávila FJ, Hernández Vásquez JR, Sicsick S, Olguín Ortega MDL, Ramos Sánchez MA, Urenda Quezada A, Tinajero Nieto L, Faccin FJ, Ramírez Ramírez MA, Serra-Bonett N, Coll Muñoz AM. Not the same, but is it the same? Cycling of biologic agents in rheumatoid arthritis. Experience in the Instituto Mexicano del Seguro Social. ACTA ACUST UNITED AC 2021; 18:361-367. [PMID: 34366291 DOI: 10.1016/j.reumae.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Available data for biocomparable drugs are not enough to make clear decisions with respect to the potential consequences of a change for non-medical reasons in efficacy, security and inmunogenicity in patients. In the near future, options on biological treatments, biocomparable drugs, non biocomparable drugs and new chemical synthesis options will grow. Therefore, it is important to know how patients behave in persistence of treatment after a change for non- medical reasons, which already happens on a regular basis in social security institutions in Mexico. This information will help us to better understand the standard of treatment for patients with chronic immunomediated conditions. OBJECTIVE The primary objective was to measure the impact of change for non-medical reasons in patients with rheumatoid arthritis (RA) treated with an innovative biological on persistence of treatment after changing to a biocomparable drug or a non-biocomparable drug, compared with those patients staying with the innovative biological. STUDY DESIGN This is an observational study (non-interventionist) of paired cohorts, where an historic cohort obtained by review of clinical records of stable patients in which no modifications to treatment were made for at least six months is compared with two cohorts of patients whose treatments were switched to another treatment with the same therapeutic mechanism for-non-medical reasons (cycling). RESULTS We included 264 RA patients (ACR/EULAR, 2010); 132 were switched for non-medical reasons, and 132 were not switched. Two-hundred and thirty (87.1%) were female. Average age was 53.9 years, ranging from 16 to 84 years. Two-hundred and sixty-three patients were Latino (99.6%); one was Caucasian. Persistence of treatment 12 months after the change was 84.8% (85.8% in Enbrel/Infinitam, 78.9% for Remicade/Remsima). No statistical difference was found with respect to RA clinical activity measured by DAS28 12 months after the switch (P > .05). In the 134 switched patients, 20 discontinued the new treatment due to lack of efficacy of the new drug and were changed to a different drug with a different biologic target. Although no differences were found in the cohorts of switched patients with respect to DAS 28 after 12 months of use, we did find differences in the frequency of adverse events. Forty-two patients had an adverse event in the drug switch cohorts: 33 in the Enbrel-Infinitam group and 9 in the Remicade-Remsima group. CONCLUSIONS The persistence of treatment after switching from an innovative drug to a biocomparable or a non- biocomparable in RA patients did not show statistically significative differences in our cohorts, but we did find a higher number of adverse events when comparing those who were changed with those who continued on an innovative drug. Twenty patients in the switch groups had to receive a new drug with a different biological target due to lack of efficacy of the switched drug.
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Affiliation(s)
- Francisco Javier Aceves-Ávila
- Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Unidad de Investigación en Enfermedades Crónico-Degenerativas S.C, Guadalajara, Jalisco, Mexico.
| | - José Ramiro Hernández Vásquez
- Departamento clínico de Reumatología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sandra Sicsick
- Hospital de Especialidades 71, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - María de Lourdes Olguín Ortega
- Servicio de Reumatología, Hospital de Especialidades, Centro Médico La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María Azucena Ramos Sánchez
- Servicio de Reumatología, Hospital de Especialidades 25, Centro Médico Nacional Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - Adelfia Urenda Quezada
- Hospital General Regional No. 1, Unidad Morelos, Instituto Mexicano del Seguro Social, Chihuahua, Chihuahua, Mexico
| | - Lizbet Tinajero Nieto
- Servicio de Reumatología, Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Querétaro, Querétaro, Mexico
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Aceves-Ávila FJ, Hernández Vásquez JR, Sicsick S, Olguín Ortega MDL, Ramos Sánchez MA, Urenda Quezada A, Tinajero Nieto L, Faccin FJ, Ramírez Ramírez MA, Serra-Bonett N, Coll Muñoz AM. Not the same, but ¿is it the same? Cycling of biologic agents in rheumatoid arthritis. Experience in the Instituto Mexicano del Seguro Social. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00060-7. [PMID: 33931335 DOI: 10.1016/j.reuma.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/31/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Available data for biocomparable drugs are not enough to make clear decisions with respect to the potential consequences of a change for non-medical reasons in efficacy, security and inmunogenicity in patients. In the near future, options on biological treatments, biocomparable drugs, non biocomparable drugs and new chemical synthesis options will grow. Therefore, it is important to know how patients behave in persistence of treatment after a change for non-medical reasons, which already happens on a regular basis in social security institutions in Mexico. This information will help us to better understand the standard of treatment for patients with chronic immunomediated conditions. OBJECTIVE The primary objective was to measure the impact of change for non-medical reasons in patients with rheumatoid arthritis (RA) treated with an innovative biological on persistence of treatment after changing to a biocomparable drug or a non-biocomparable drug, compared with those patients staying with the innovative biological. STUDY DESIGN This is an observational study (non-interventionist) of paired cohorts, where an historic cohort obtained by review of clinical records of stable patients in which no modifications to treatment were made for at least six months is compared with two cohorts of patients whose treatments were switched to another treatment with the same therapeutic mechanism for-non-medical reasons (cycling). RESULTS We included 264 RA patients (ACR/EULAR, 2010); 132 were switched for non-medical reasons, and 132 were not switched. Two-hundred and thirty (87.1%) were female. Average age was 53.9years, ranging from 16 to 84years. Two-hundred and sixty-three patients were Latino (99.6%); one was Caucasian. Persistence of treatment 12months after the change was 84.8% (85.8% in Enbrel/Infinitam, 78.9% for Remicade/Remsima). No statistical difference was found with respect to RA clinical activity measured by DAS28 12months after the switch (P>.05). In the 134 switched patients, 20 discontinued the new treatment due to lack of efficacy of the new drug and were changed to a different drug with a different biologic target. Although no differences were found in the cohorts of switched patients with respect to DAS28 after 12months of use, we did find differences in the frequency of adverse events. Forty-two patients had an adverse event in the drug switch cohorts: 33 in the Enbrel-Infinitam group and 9 in the Remicade-Remsima group. CONCLUSIONS The persistence of treatment after switching from an innovative drug to a biocomparable or a non-biocomparable in RA patients did not show statistically significative differences in our cohorts, but we did find a higher number of adverse events when comparing those who were changed with those who continued on an innovative drug. Twenty patients in the switch groups had to receive a new drug with a different biological target due to lack of efficacy of the switched drug.
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Affiliation(s)
- Francisco Javier Aceves-Ávila
- Hospital General Regional No. 46, Instituto Mexicano del Seguro Social. Unidad de Investigación en Enfermedades Crónico-Degenerativas S.C, Guadalajara, Jalisco, México.
| | - José Ramiro Hernández Vásquez
- Departamento clínico de Reumatología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sandra Sicsick
- Hospital de Espacialidades 71, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - María de Lourdes Olguín Ortega
- Servicio de Reumatología, Hospital de Especialidades, Centro Médico La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - María Azucena Ramos Sánchez
- Servicio de Reumatología, Hospital de Especialidades 25, Centro Médico Nacional Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Adelfia Urenda Quezada
- Hospital General Regional No. 1 Unidad Morelos, Instituto Mexicano del Seguro Social, Chihuahua, Chihuahua, México
| | - Lizbet Tinajero Nieto
- Servicio de Reumatología, Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Querétaro, Querétaro, México
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Spineli LM, Kalyvas C, Pateras K. Participants' outcomes gone missing within a network of interventions: Bayesian modeling strategies. Stat Med 2019; 38:3861-3879. [PMID: 31134664 PMCID: PMC7754380 DOI: 10.1002/sim.8207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
Abstract
Objectives: To investigate the implications of addressing informative missing binary outcome data (MOD) on network meta‐analysis (NMA) estimates while applying the missing at random (MAR) assumption under different prior structures of the missingness parameter. Methods: In three motivating examples, we compared six different prior structures of the informative missingness odds ratio (IMOR) parameter in logarithmic scale under pattern‐mixture and selection models. Then, we simulated 1000 triangle networks of two‐arm trials assuming informative MOD related to interventions. We extended the Bayesian random‐effects NMA model for binary outcomes and node‐splitting approach to incorporate these 12 models in total. With interval plots, we illustrated the posterior distribution of log OR, common between‐trial variance (τ2), inconsistency factor and probability of being best per intervention under each model. Results: All models gave similar point estimates for all NMA estimates regardless of simulation scenario. For moderate and large MOD, intervention‐specific prior structure of log IMOR led to larger posterior standard deviation of log ORs compared to trial‐specific and common‐within‐network prior structures. Hierarchical prior structure led to slightly more precise τ2 compared to identical prior structure, particularly for moderate inconsistency and large MOD. Pattern‐mixture and selection models agreed for all NMA estimates. Conclusions: Analyzing informative MOD assuming MAR with different prior structures of log IMOR affected mainly the precision of NMA estimates. Reviewers should decide in advance on the prior structure of log IMOR that best aligns with the condition and interventions investigated.
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Affiliation(s)
- Loukia M Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Chrysostomos Kalyvas
- Department of Biostatistics and Research Decision Sciences, MSD Europe Inc, Brussels, Belgium
| | - Konstantinos Pateras
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Camean-Castillo M, Gimeno-Ballester V, Rios-Sanchez E, Fenix-Caballero S, Vázquez-Real M, Alegre-Del Rey E. Network meta-analysis of tofacitinib versus biologic treatments in moderate-to-severe rheumatoid arthritis patients. J Clin Pharm Ther 2019; 44:384-396. [PMID: 30729557 DOI: 10.1111/jcpt.12795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 01/11/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Rheumatoid arthritis (RA) is an autoimmune disease characterized primarily by inflammation and pain in the joints. Tofacitinib is an oral drug recently approved for RA treatment; it inhibits Janus protein kinases (JAK) that reduces RA symptoms when conventional DMARDs do not trigger a response. This study aimed to compare the efficacy of biological DMARDs in monotherapy or combined with methotrexate in RA patients and compare the treatments. METHODS We reviewed the literature for articles published up to June 2017, evaluating the efficacy and safety of the biological DMARDs indicated for RA in patients with inadequate responses to conventional DMARDs and naïve to biological DMARDs, in similar populations, considering ACR50 as the efficacy variable. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each drug combination, and these parameters were transformed into differences in responses to assess the effectiveness of the alternative medicines. Equivalence therapeutic alternatives (ETA) were ensured to assess the possibility of considering these medications with equivalent efficacy. A network meta-analysis (NMA) was performed using Bayesian approaches and the fixed-effects model. RESULTS AND DISCUSSION Twenty-seven randomized clinical trials (RCTs) that met the pre-established criteria were identified. The 95% CI of biological DMARDs was higher than that of placebo without methotrexate, except for certolizumab, golimumab-m, anakinra-m and adalimumab monotherapy. These DMARDs performed significantly better than the placebo, except for etanercept, certolizumab, tofacitinib and golimumab. Certolizumab-m was better than anakinra-m and adalimumab, and tocilizumab alone or combined with methotrexate was superior to adalimumab. Etanercept-m yielded a higher difference in responses compared with the other biological DMARDs, which presented more homogeneous responses, except for adalimumab and anakinra-m, which yielded worse results. None of the biological DMARDs displayed ETA to etanercept-m; however, they displayed ETA with certolizumab-m, except for adalimumab and anakinra-m. WHAT IS NEW AND CONCLUSION All biological DMARDs used in combination with methotrexate, except for etanercept, anakinra, certolizumab and tocilizumab without methotrexate, were displayed ETA on using ACR50 at week 24 in patients naïve to biological DMARDs. Etanercept displayed a greater difference in responses, although the high uncertainty of the comparative results prevented the confirmation of the increased efficacy of this drug.
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Lee MY, Shin JY, Park SY, Kim D, Cha HS, Lee EK. Persistence of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: An analysis of the South Korean National Health Insurance Database. Semin Arthritis Rheum 2018; 47:485-491. [DOI: 10.1016/j.semarthrit.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/08/2017] [Accepted: 08/24/2017] [Indexed: 10/19/2022]
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Sheppard M, Laskou F, Stapleton PP, Hadavi S, Dasgupta B. Tocilizumab (Actemra). Hum Vaccin Immunother 2017; 13:1972-1988. [PMID: 28841363 PMCID: PMC5612212 DOI: 10.1080/21645515.2017.1316909] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 12/11/2022] Open
Abstract
Tocilizumab (TCZ), is a recombinant humanized anti-interleukin-6 receptor (IL-6R) monoclonal antibody which has a main use in the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis (sJIA) and polyarticular juvenile idiopathic arthritis (pJIA). This article provides an overview of TCZ including looking into the past at the discovery of interleukin-6 (IL-6) as a pro-inflammatory cytokine. It also looks at how tocilizumab was developed, manufactured and tested to ensure both safety and efficacy in a human population. The article then explores the advantages and disadvantages of using TCZ when compared to other biologics approved in RA, sJIA and pJIA and finally looks ahead to the future and the emerging role of IL-6 and its blockade by TCZ as a treatment for giant cell arteritis (GCA), polymyalgia rheumatica (PMR) and large vessel vasculitis (LVV).
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MESH Headings
- Animals
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/immunology
- Drug Approval
- Humans
- Interleukin-6/immunology
- Polymyalgia Rheumatica/drug therapy
- Receptors, Interleukin-6/antagonists & inhibitors
- Receptors, Interleukin-6/immunology
- Vasculitis/drug therapy
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Affiliation(s)
- Martin Sheppard
- Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK
| | - Faidra Laskou
- Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK
| | | | - Shahryar Hadavi
- Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK
| | - Bhaskar Dasgupta
- Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK
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Choi M, Hyun MK, Choi S, Tchoe HJ, Lee SY, Son KM, Kim MJ, Jung YO, Kim HA. Comparative efficacy of biological agents in methotrexate-refractory rheumatoid arthritis patients: a Bayesian mixed treatment comparison. Korean J Intern Med 2017; 32:536-547. [PMID: 27253239 PMCID: PMC5432786 DOI: 10.3904/kjim.2015.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/06/2015] [Accepted: 06/26/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Biological agents (biologics) targeting proinflammatory signaling have emerged as an important treatment option in rheumatoid arthritis (RA). Despite the clinical effectiveness of biologics for patients with RA who do not respond to 'traditional' disease-modifying anti-rheumatic drugs (DMARDs), there are concerns regarding their cost and long-term safety. In this study, we aimed to compare the efficacy of various biologics and traditional DMARDs in RA patients refractory to methotrexate (MTX). METHODS Four DMARDs (hydroxychloroquine, sulfasalazine, MTX, lef lunomide) and five anti-tumor necrosis factor drugs (adalimumab, etanercept, golimumab, inf liximab, and certolizumab) were selected. A systematic search of published studies was performed from inception through July 2013. Randomized trials of adults with MTX-refractory RA comparing two or more of the selected medications were included. Among 7,938 titles identified, in total, 16 head-to-head trials were selected. Two reviewers independently abstracted the study data and assessed methodological quality using the Cochrane Risk of Bias. Comparative efficacy was analyzed using a Bayesian mixed treatment comparison (MTC). RESULTS In total, 9, 4, and 11 studies were included for the outcome measures of the Health Assessment Questionnaire (HAQ), Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) < 2.6 (remission), and American College of Rheumatology (ACR) 70 response, respectively. The treatments with the highest efficacy for each outcome measure were certolizumab combined with MTX, golimumab combined with MTX, and certolizumab combined with MTX, respectively. CONCLUSIONS Based on MTC analysis, using data from published randomized controlled trials, certolizumab and golimumab combined with MTX showed the highest efficacy in the three outcome measures (HAQ, DAS28-ESR < 2.6, and ACR 70 response) in MTX-refractory RA patients.
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Affiliation(s)
- Miyoung Choi
- National Evidence-Based Healthcare Collaboration Agency (NECA), Seoul, Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, Dongguk University College of Korean Medicine, Seoul, Korea
| | - Seongmi Choi
- Korea Appraisal Board, Real Estate R&D Institute, Seoul, Korea
| | - Ha Jin Tchoe
- National Evidence-Based Healthcare Collaboration Agency (NECA), Seoul, Korea
| | - Sung Yeon Lee
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyeong Min Son
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Min-Jeong Kim
- National Evidence-Based Healthcare Collaboration Agency (NECA), Seoul, Korea
| | - Young Ok Jung
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Correspondence to Young Ok Jung, M.D. Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-845-5305 Fax: +82-2-846-4669 E-mail:
| | - Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Gossen N, Jacob L, Kostev K. Second-line therapy with biological drugs in rheumatoid arthritis patients in German rheumatologist practices: a retrospective database analysis. Rheumatol Int 2016; 36:1113-8. [DOI: 10.1007/s00296-016-3448-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/18/2016] [Indexed: 12/19/2022]
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Kubota T, Imanaka H, Takei S, Yamatou T, Nerome Y, Yamasaki Y, Nonaka Y, Akaike H, Takezaki T, Kawano Y. Disease activity score in 28 joints at 3 months after the initiation of biologic agent can be a predictive target for switching to the second biologic agent in patients with polyarticular juvenile idiopathic arthritis. Mod Rheumatol 2015; 26:358-61. [PMID: 26444450 DOI: 10.3109/14397595.2015.1083147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To clarify polyarticular juvenile idiopathic arthritis (pJIA) patients who failed to maintain prolonged remission with the first biologic agent. METHODS Fourteen pJIA patients were observed for 47.5 months (median) after initiating the first biologic agent. RESULTS Eight maintained sustained clinical remission (median 47 months) with the first biologic agents, while the six switched to the second one due to lack of efficacy, thereafter. Receiver operating characteristic (ROC) analysis revealed that disease activity score in 28 joints (DAS28) of 2.37 at 3 months could distinguish between the two patient groups (p = 0.001). CONCLUSION pJIA patients with DAS28 >2.37 at 3 months of the initial biologic therapy may be considered to switch to the second biologics.
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Cost analysis of biologic drugs in rheumatoid arthritis first line treatment after methotrexate failure according to patients' body weight. ACTA ACUST UNITED AC 2015; 12:123-9. [PMID: 26362842 DOI: 10.1016/j.reuma.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/15/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective was to assess the influence of patients' weight in the cost of rheumatoid arthritis treatment with biologic drugs used in first line after non-adequate response to methotrexate. PATIENTS AND METHOD Pharmaceutical and administration costs were calculated in two scenarios: non-optimization and optimization of intravenous (IV) vials. The retrospective analysis of 66 patients from a Spanish 1,000 beds-hospital Rheumatology Clinic Service was used to obtain posology and weight data. The study time horizon was two years. Costs were expressed in 2013 euros. RESULTS For an average 69kg-weighted patient the lowest cost corresponded to abatacept subcutaneous (SC ABA) (€21,028.09) in the scenario without IV vials optimization and infliximab (IFX) (€20,779.29) with optimization. Considering patients' weight in the scenario without IV vials optimization infliximab (IFX) was the least expensive drug in patients ranged 45-49kg, IV ABA in 50-59kg and SC ABA in patients over 60kg. With IV vials optimization IFX was the least expensive drug in patients under 69kg and SC ABA over 70kg. CONCLUSIONS Assuming comparable effectiveness of biological drugs, patient's weight is a variable to consider, potentials savings could reach €20,000 in two years.
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Migliore A, Bizzi E, Egan CG, Bernardi M, Petrella L. Efficacy of biological agents administered as monotherapy in rheumatoid arthritis: a Bayesian mixed-treatment comparison analysis. Ther Clin Risk Manag 2015; 11:1325-35. [PMID: 26366085 PMCID: PMC4562742 DOI: 10.2147/tcrm.s89678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Biological agents provide an important therapeutic alternative for rheumatoid arthritis patients refractory to conventional disease-modifying antirheumatic drugs. Few head-to-head comparative trials are available. PURPOSE The aim of this meta-analysis was to compare the relative efficacy of different biologic agents indicated for use as monotherapy in rheumatoid arthritis. METHODS A systemic literature search was performed on electronic databases to identify articles reporting double-blind randomized controlled trials investigating the efficacy of biologic agents indicated for monotherapy. Efficacy was assessed using American College of Rheumatology (ACR) 20, 50, and 70 criteria at 16-24 weeks. Relative efficacy was estimated using Bayesian mixed-treatment comparison models. Outcome measures were expressed as odds ratio and 95% credible intervals. RESULTS Ten randomized controlled trials were selected for data extraction and analysis. Mixed-treatment comparison analysis revealed that tocilizumab offered 100% probability of being the best treatment for inducing an ACR20 response versus placebo, methotrexate, adalimumab, or etanercept. Likewise, for ACR50 and ACR70 outcome responses, tocilizumab had a 99.8% or 98.7% probability of being the best treatment, respectively, compared to other treatments or placebo. Tocilizumab increased the relative probability of being the best treatment (vs methotrexate) by 3.2-fold (odds ratio: 2.1-3.89) for all ACR outcomes. CONCLUSION Tocilizumab offered the greatest possibility of obtaining an ACR20, ACR50, and ACR70 outcome vs other monotherapies or placebo.
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Affiliation(s)
- Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Emanuele Bizzi
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | - Mauro Bernardi
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Lea Petrella
- MEMOTEF Department, Sapienza University of Rome, Rome, Italy
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12
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Isyar M, Bilir B, Yilmaz I, Cakmak S, Sirin DY, Guzelant AY, Mahirogullari M. Are biological agents toxic to human chondrocytes and osteocytes? J Orthop Surg Res 2015. [PMID: 26223355 PMCID: PMC4520184 DOI: 10.1186/s13018-015-0264-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of the present study is to investigate the effects of biological agents (BAs) on human chondrocytes and osteocytes in vitro. Methods Primary cell cultures obtained from gonarthrosis patients were divided into four groups, two of which were designated as control cultures of chondrocyte and osteocyte, and the other two groups were exposed to BAs administered via the culture medium. Cultured cells were characterized by immunophenotyping. Before and after administration of the agents, the cultures were observed by inverted and environmental scanning electron microscopy (ESEM). The number of live cells and the proliferation rate were monitored by MTT assay. Results Rituximab and adalimumab were the least toxic agents to chondrocytes, whereas adalimumab and etanercept were to osteocytes. Conclusion During periods of intense active inflammation, the concentration of the preferred BAs after inhibition of inflammation needs to be emphasized when their effects on cartilage and bone tissue are considered at the cellular level if the clinical practice is to continue.
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Affiliation(s)
- Mehmet Isyar
- Department of Orthopaedic and Traumatology, School of Medicine, Istanbul Medipol University, Bagcilar, 34214, Istanbul, Turkey.
| | - Bulent Bilir
- Department of Internal Medicine, School of Medicine, Namik Kemal University, 59100, Tekirdag, Turkey.
| | - Ibrahim Yilmaz
- Department of Pharmacovigilance and Rational Drug Use Team, Republic of Turkey, Ministry of Health, State Hospital, 59100, Tekirdag, Turkey.
| | - Selami Cakmak
- Department of Orthopaedic and Traumatology, Haydarpasa Training Hospital, Gulhane Military Medical Academy, 34668, Istanbul, Turkey.
| | - Duygu Yasar Sirin
- Faculty of Science, Department of Molecular Biology and Genetics, Namik Kemal University, 59100, Tekirdag, Turkey.
| | - Aliye Yildirim Guzelant
- Department of Physical Medicine and Rehabilitation, School of Medicine, Namik Kemal University, 59100, Tekirdag, Turkey.
| | - Mahir Mahirogullari
- Department of Orthopaedic and Traumatology, School of Medicine, Istanbul Medipol University, Bagcilar, 34214, Istanbul, Turkey.
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Comparative Effectiveness of Tocilizumab and TNF Inhibitors in Rheumatoid Arthritis Patients: Data from the Rheumatic Diseases Portuguese Register, Reuma.pt. BIOMED RESEARCH INTERNATIONAL 2015; 2015:279890. [PMID: 26000286 PMCID: PMC4427085 DOI: 10.1155/2015/279890] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/11/2015] [Indexed: 01/10/2023]
Abstract
Objectives. To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria. Methods. We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders. Results. Tocilizumab-treated patients (n = 95) presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (n = 429). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6–21.6/3.2–12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2–6.5/1.3–5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5–8.7/1.1–5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4–12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8–4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8–4.5). Conclusions. Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups.
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Messori A, Fadda V, Maratea D, Trippoli S, Gatto R, De Rosa M, Marinai C. Biological drugs for the treatment of rheumatoid arthritis by the subcutaneous route: interpreting efficacy data to assess statistical equivalence. Ther Adv Musculoskelet Dis 2014; 6:207-16. [PMID: 25435923 DOI: 10.1177/1759720x14554792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND No equivalence analysis has yet been conducted on the effectiveness of biologics in rheumatoid arthritis. Equivalence testing has a specific scientific interest, but can also be useful for deciding whether acquisition tenders are feasible for the pharmacological agents being compared. METHODS Our search covered the literature up to August 2014. Our methodology was a combination of standard pairwise meta-analysis, Bayesian network meta-analysis and equivalence testing. The agents examined for their potential equivalence were etanercept, adalimumab, golimumab, certolizumab, and tocilizumab, each in combination with methotrexate (MTX). The reference treatment was MTX monotherapy. The endpoint was ACR50 achievement at 12 months. Odds ratio was the outcome measure. The equivalence margins were established by analyzing the statistical power data of the trials. RESULTS Our search identified seven randomized controlled trials (2846 patients). No study was retrieved for tocilizumab, and so only four biologics were evaluable. The equivalence range was set at odds ratio from 0.56 to 1.78. There were 10 head-to-head comparisons (4 direct, 6 indirect). Bayesian network meta-analysis estimated the odds ratio (with 90% credible intervals) for each of these comparisons. Between-trial heterogeneity was marked. According to our results, all credible intervals of the 10 comparisons were wide and none of them satisfied the equivalence criterion. A superiority finding was confirmed for the treatment with MTX plus adalimumab or certolizumab in comparison with MTX monotherapy, but not for the other two biologics. CONCLUSION Our results indicate that these four biologics improved the rates of ACR50 achievement, but there was an evident between-study heterogeneity. The head-to-head indirect comparisons between individual biologics showed no significant difference, but failed to demonstrate the proof of no difference (i.e. equivalence). This body of evidence presently precludes any option of undertaking competitive tenderings for the procurement of these agents.
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Affiliation(s)
- Andrea Messori
- HTA Unit, Area Vasta Centro Toscana, Regional Health System, Via San Salvi 12, 50100 Firenze, Italy
| | - Valeria Fadda
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Dario Maratea
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Sabrina Trippoli
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Roberta Gatto
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Mauro De Rosa
- President, SIFACT, Italian Society for Clinical Pharmacy and Therapeutics, Milano, Italy
| | - Claudio Marinai
- Department of Pharmaceutical Logistics, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
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15
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¿Cómo comparar fármacos biológicos? ACTA ACUST UNITED AC 2014; 10:353-9. [DOI: 10.1016/j.reuma.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/04/2014] [Accepted: 06/15/2014] [Indexed: 12/17/2022]
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16
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Alegre Del Rey EJ, Fénix Caballero S, Castaño Lara R, Sierra García F. [Assessment and positioning of drugs as equivalent therapeutic alternatives]. Med Clin (Barc) 2014; 143:85-90. [PMID: 24480291 DOI: 10.1016/j.medcli.2013.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/21/2013] [Accepted: 11/28/2013] [Indexed: 11/27/2022]
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17
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Armuzzi A, Lionetti P, Blandizzi C, Caporali R, Chimenti S, Cimino L, Gionchetti P, Girolomoni G, Lapadula G, Marchesoni A, Marcellusi A, Mennini FS, Salvarani C, Cimaz R. anti-TNF agents as therapeutic choice in immune-mediated inflammatory diseases: focus on adalimumab. Int J Immunopathol Pharmacol 2014; 27:11-32. [PMID: 24774504 DOI: 10.1177/03946320140270s102] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The complex pathogenesis of immune-mediated inflammatory diseases (IMIDs) has been extensively investigated and dysregulation of cytokines, such as tumour necrosis factor (TNF) has been shown to play a dominant role in the pathogenesis of various IMIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis and psoriatic arthritis. The subsequent development of biological agents capable of blocking TNF has led to important advances in the pharmacotherapy of such diseases and confirmed the concept of a common pathophysiology among IMIDs with TNF having a predominant role. Five TNF inhibitors have currently been approved for treatment of one or more IMIDs; these include infliximab, etanercept, adalimumab, golimumab and certolizumab pegol. Given the similarities in the pathogenic background of IMIDs, one could expect that anti-TNF agents be similarly effective and with comparable tolerability profiles; however, this may not be the case. Structural and pharmacological differences among the anti-TNF drugs are likely to result in differences in efficacy and tolerability among the agents in the different IMIDs, together with differences in potency, therapeutic dose ranges, dosing regimens, administration routes, and propensity for immunogenicity. Among the five TNF inhibitors approved for treatment of IMIDs, adalimumab has the widest range of indications. Data from controlled clinical trials of adalimumab, showing its excellent efficacy and tolerability in a wide range of indications, are supported by real-world long-term data from observational studies, which confirm the value of adalimumab as a suitable choice in the management of IMIDs.
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Affiliation(s)
- A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - P Lionetti
- Gastroenterology Unit, Anna Meyer Childrens Hospital, Department of Paediatrics, University of Firenze, Firenze, Italy
| | - C Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - L Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Reggio, Emilia, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari, Bari, Italy
| | | | - A Marcellusi
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F S Mennini
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - R Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Childrens Hospital, University of Florence, Firenze, Italy
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Tanaka T, Hishitani Y, Ogata A. Monoclonal antibodies in rheumatoid arthritis: comparative effectiveness of tocilizumab with tumor necrosis factor inhibitors. Biologics 2014; 8:141-53. [PMID: 24741293 PMCID: PMC3984066 DOI: 10.2147/btt.s37509] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation, systemic inflammation, and immunological abnormalities. Because cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-6 play a major role in the development of RA, their targeting could constitute a reasonable novel therapeutic strategy for treating RA. Indeed, worldwide clinical trials of TNF inhibiting biologic disease modifying antirheumatic drugs (bDMARDs) including infliximab, adalimumab, golimumab, certolizumab pegol, and etanercept as well as the humanized anti-human IL-6 receptor antibody, tocilizumab, have demonstrated outstanding clinical efficacy and tolerable safety profiles, resulting in worldwide approval for using these bDMARDs to treat moderate to severe active RA in patients with an inadequate response to synthetic disease modifying antirheumatic drugs (sDMARDs). Although bDMARDs have elicited to a paradigm shift in the treatment of RA due to the prominent efficacy that had not been previously achieved by sDMARDs, a substantial percentage of patients failed primary or secondary responses to bDMARD therapy. Because RA is a heterogeneous disease in which TNF-α and IL-6 play overlapping but distinct pathological roles, further studies are required to determine the best use of TNF inhibitors and tocilizumab in individual RA patients.
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Affiliation(s)
- Toshio Tanaka
- Department of Clinical Application of Biologics, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan ; Department of Immunopathology, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Yoshihiro Hishitani
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Ogata
- Department of Immunopathology, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan ; Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
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Current World Literature. Curr Opin Rheumatol 2013; 25:398-409. [DOI: 10.1097/bor.0b013e3283604218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Galván-Banqueri M, Marín Gil R, Santos Ramos B, Bautista Paloma FJ. Biological treatments for moderate-to-severe psoriasis: indirect comparison. J Clin Pharm Ther 2013; 38:121-30. [PMID: 23442134 DOI: 10.1111/jcpt.12044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/12/2012] [Indexed: 12/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Psoriasis is a chronic skin disease for which there is an increasing range of treatment options. Biological agents (ustekinumab, adalimumab, infliximab and etanercept) are indicated for moderate-to-severe plaque-type psoriasis in adults who fail to respond to, have a contraindication to, or are intolerant to other systemic therapies including cyclosporine, methotrexate and PUVA Unfortunately, with new drugs, the pivotal trials leading to their licensing are often placebo-controlled trials rather than comparative trials vs. established therapies. Therefore, inference on comparative effectiveness of the newer agents must be derived indirectly, through estimation of effects of the new agents vs. a common comparator. The objective of this study is to compare the relative efficacy of the biological agents through a systematic review of the indirect clinical trial evidence. METHODS A systematic literature search was performed for clinical trials of biological agents in psoriasis. Pivotal, randomized, double-blind, controlled (placebo) trials using intention-to-treat analysis were selected for detailed analysis. Trials must include PASI 75 as a primary end point. The indirect comparison was performed using the method of Bucher adjusted with the ITC calculator (Indirect Treatment Comparisons of the Canadian Agency for Drugs and Technologies in Health), etanercept being the reference drug. We defined delta value for therapeutic equivalence as a difference in the efficacy of 25% among the different treatment options. RESULTS AND DISCUSSION Fourteen studies (four for ustekinumab, three for adalimumab, three for infliximab and four for etanercept) were included. The indirect comparison results reveal that ustekinumab, adalimumab and infliximab were statistically superior to etanercept with an absolute risk difference for PASI 75 of 12% (95% CI = 5·9-18%), 11% (95% CI = 5·3-16·7%) and 24% (29·7-18·3%) respectively. However, in all situations, the 95% confidence interval does not achieve clinical relevance as no delta exceeds the previously set value (25%). WHAT IS NEW AND CONCLUSION Ustekinumab, adalimumab, infliximab and etanercept can be regarded as clinical equivalents for the treatment of psoriasis. Choice between these agents therefore depends on their relative safety profiles, individual contra-indications and cost effectiveness.
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Affiliation(s)
- M Galván-Banqueri
- Andalusian Public Foundation for the Management of Health Research, Sevilla, Spain.
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Otten MH, Anink J, Spronk S, van Suijlekom-Smit LWA. Efficacy of biological agents in juvenile idiopathic arthritis: a systematic review using indirect comparisons. Ann Rheum Dis 2012; 72:1806-12. [PMID: 23172748 DOI: 10.1136/annrheumdis-2012-201991] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Marieke H Otten
- Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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