medwireNews: Findings from a systematic review and network meta-analysis indicate that adding sarilumab to conventional DMARDs may be beneficial for patients with rheumatoid arthritis (RA) and an inadequate response to either conventional DMARDs or tumor necrosis factor (TNF) inhibitors.
“Given the variety of treatments currently available for RA, a comprehensive evaluation of the comparative effectiveness and safety of sarilumab against other DMARDs is necessary to inform treatment decisions and health technology assessments, as well as to guide evidence-based medicine,” say Thi-Minh-Thao Huynh (Sanofi France, Chilly-Mazarin) and co-authors.
The network meta-analysis included 46 trials involving participants with an inadequate response to prior treatment with conventional synthetic DMARDs (csDMARD-IR group), and eight trials in which patients had an inadequate response to TNF inhibitors (TNFi-IR group). Patient numbers included in the trials varied from less than 40 to more than 400 per group, and the trials lasted between 24 and 104 weeks.
Among csDMARD-IR patients, those treated with sarilumab at a dose of 150 mg or 200 mg every 2 weeks alongside csDMARDs had significantly better outcomes – including ACR20, 50, and 70 responses, rates of remission according to DAS28 below 2.6 points, and changes in mTSS score.
The researchers also compared the efficacy of sarilumab to a number of targeted DMARDs such as baricitinib, adalimumab, etanercept, golimumab, infliximab, and tocilizumab in this patient population. They found no statistically significant differences in the majority of outcomes among the groups, but patients treated with sarilumab plus csDMARDs had significantly less disease progression as measured by changes in the mTSS score over 24 weeks than those treated with baricitinib 2 mg, tofacitinib, or certolizumab in combination with csDMARDs.
In accordance with their findings in the csDMARD-IR group, Huynh and team demonstrated significantly better ACR20, 50, and 70 responses and rates of remission among patients in the TNFi-IR group treated with sarilumab plus csDMARDs compared with csDMARDs alone.
A significantly higher proportion of TNFi-IR patients treated with sarilumab 200 mg versus baricitinib 2 mg, abatacept, golimumab, tocilizumab 4 mg/kg, or rituximab achieved remission, but sarilumab at this dose had a comparable effect to that of the other targeted DMARDs for the majority of other outcomes, as did sarilumab 150 mg.
The investigators note that rates of serious adverse events, including infections, “appeared similar for sarilumab versus comparators” in both the csDMARD-IR and TNFi-IR groups.
They conclude in RMD Open: “Physicians may use these results from this clinical study to inform treatment decisions for patients with RA.”
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