title: Clinical effectiveness of biologics in clinical practice.
abstract: TNF inhibitors are currently considered both effective and cost-effective in patients with active rheumatoid arthritis (RA), particularly in patients who have not responded fully to methotrexate. There is substantial doubt about the cost-effectiveness of TNF inhibitors as initial treatment for active RA. New data from the National Data Bank for Rheumatic Diseases now question the current consensus in methotrexate failures. The data suggest that in routine clinical practice TNF inhibitors provide only modest incremental benefits over best conventional therapy. If confirmed, these observational studies suggest that the economic argument underpinning the widespread use of TNF inhibitors in established RA is unsustainable.
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kingsley
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
references.citation: Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S20-7
references.pmid: 14969046
references.citation: BMJ. 2009 Mar 16;338:b702
references.pmid: 19289413
references.citation: J Rheumatol. 2009 Aug;36(8):1596-9
references.pmid: 19531746
references.citation: Rheumatology (Oxford). 2007 Aug;46(8):1345-54
references.pmid: 17562686
references.citation: Arthritis Rheum. 2006 Nov;54(11):3399-407
references.pmid: 17075823
references.citation: Ann Intern Med. 2009 Nov 3;151(9):612-21
references.pmid: 19884622
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007848
references.pmid: 19821440
references.citation: Rheumatology (Oxford). 2010 Jan;49(1):91-8
references.pmid: 19917618
references.citation: Arthritis Rheum. 2008 Apr;58(4):939-46
references.pmid: 18383356
references.citation: Arthritis Res Ther. 2010;12(2):R35
references.pmid: 20196859
references.citation: Ann Rheum Dis. 2005 Jul;64(7):995-1002
references.pmid: 15550533
references.citation: J Manag Care Pharm. 2006 Sep;12(7):555-69
references.pmid: 16981801