medwireNews: A systematic review and network meta-analysis finds few significant differences in the benefits and harms associated with different biologics when given in combination with methotrexate for the treatment of rheumatoid arthritis (RA).
“This information could be important for clinical practice, considering the changes in treatment strategies for rheumatoid arthritis and the increasing number of biosimilar biological medicines available,” say the study authors in The BMJ.
Beate Wieseler (Institute for Quality and Efficiency in Health Care, Cologne, Germany) and colleagues’ analysis included data from 38 published and unpublished randomized trials investigating eight different biologic agents given in combination with methotrexate.
They note that “an important prerequisite” for network meta-analyses comparing multiple treatment options is the similarity of included studies, which they achieved by “using aggregate results from systematic reanalyses of individual patient data performed by study sponsors for those studies with heterogeneous populations.”
The team found only “minor differences” between the combination treatments. For example, RA patients had better outcomes in terms of clinical remission with adalimumab, certolizumab pegol, and golimumab compared with anakinra (risk ratio [RR]=3.6–4.7), and greater benefits in terms of low disease activity for abatacept, adalimumab, infliximab, and tocilizumab versus anakinra (RR=1.46–2.87).
And in the safety analysis, certolizumab pegol was associated with a significantly greater risk for infection compared with abatacept, anakinra, etanercept, golimumab, and tocilizumab (RR=1.35–1.53).
“Except for anakinra, the lack of proven added benefit of one biological medicine combined with methotrexate over another means that all combinations are similarly suitable treatment choices,” write the study authors.
“The choice of a specific biological medicine should therefore be based on relevant patient characteristics, including comorbidities (if possible) and patients’ preferences,” they add, noting that “the cost of treatment should [also] be considered.”
Wieseler et al caution that some of the confidence intervals of their estimates were “very wide” due to low event numbers for some of the outcomes studied, and that “results were mainly based on indirect comparisons” due to a lack of head-to-head trials of different biologics, with the inclusion of just two studies reporting direct comparisons.
“Therefore, we could only derive conclusions of low certainty,” they say.
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