Mixed Treatment Comparison of the Treatment Discontinuations of Biologic Disease-Modifying Antirheumatic Drugs in Adults with Rheumatoid Arthritis

Annals of Pharmacotherapy - Tập 46 Số 11 - Trang 1491-1505 - 2012
Rishi Desai1, Richard A. Hansen2, Jaya K. Rao3, Tania M Wilkins4, Elizabeth Harden5, Andrea Yuen6, Daniel E Jonas7, Robert Roubey8, Beth M. Jonas9, Gerald Gartlehner10, Linda J Lux11, Katrina E Donahue12
1Rishi J Desai MS, PhD Candidate, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
2Richard A Hansen PhD, Sandra Kent Gilliland & David Louie Gilliland Professor and Department Head, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, AL
3Jaya K Rao MD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina
4Tania M Wilkins MS, Senior Biostatistician, Department of Biostatistics, University of North Carolina
5Elizabeth A Harden MPH, Project Coordinator, Department of Biostatistics, University of North Carolina
6Andrea Yuen BS, Research Analyst, RTI International, Research Triangle Park, NC
7Daniel E Jonas MD MPH, Co-Director, RTI-UNC Evidence-Based Practice Center, Cecil G. Sheps Center for Health Services Research; Assistant Professor, Division of General Medicine, Department of Medicine, University of North Carolina
8Robert Roubey MD, Associate Professor, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina
9Beth Jonas MD MPH, Associate Professor, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina
10Gerald Gartlehner MD MPH, Professor and Department Chair, Department of Evidence-Based Medicine and CLinical Epidemiology, Danube University, Krems, Austria
11Linda Lux MPA, RTI-UNC EPC Administrator, RTI International
12Katrina E Donahue MD MPH, Associate Professor, Department of Medicine, University of North Carolina

Tóm tắt

BACKGROUND: Introduction of biologic disease-modifying antirheumatic drugs (DMARDs) has considerably changed treatment options for rheumatoid arthritis (RA) over the past decade. Very little information is available on comparative discontinuation rates of the biologics. OBJECTIVE: To compare treatment discontinuations for 9 biologic DMARDs in adults with RA. METHODS: We searched electronic databases through May 2012 to retrieve randomized controlled trials (RCTs) of patients with RA that compared biologic DMARDs with placebo or another biologic DMARD. The primary outcome was treatment discontinuation during the blinded phase of the trials, measured as overall withdrawals, withdrawals resulting from lack of efficacy, and withdrawals resulting from adverse events. Random-effects meta-analysis estimated the effect size for individual agents, and adjusted indirect comparisons were made between biologics using mixed treatment comparisons (MTC) meta-analysis. RESULTS: Forty-four trials were included in the analysis. In comparison with placebo, biologics were less likely to be withdrawn because of lack of efficacy (OR 0.22, 95% CI 0.17 to 0.27) and more likely to be withdrawn because of an adverse event (OR 1.41, 95% CI 1.16 to 1.70). Based on the MTC, certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates resulting from lack of efficacy than adalimumab, anakinra, and infliximab. Anakinra had higher relative withdrawal rates resulting from lack of efficacy than most other biologics. Certolizumab and infliximab had more, while etanercept had fewer, withdrawals because of adverse events than most other drugs. CONCLUSIONS: Based on MTC using data from RCTs, differences in discontinuation rates were observed, generally favoring certolizumab, etanercept, and rituximab over other biologic DMARDs. These potential differences need to be further explored in head-to-head trials or well-conducted observational studies.

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Annals of Pharmacotherapy

Tập 46 Số 11

1491-1505

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