title: Indirect comparison of anti-TNF-α agents for active ankylosing spondylitis: mixed treatment comparison of randomized controlled trials.
abstract: OBJECTIVE
  We aimed to identify different anti-TNF-α agents for ankylosing spondylitis (AS) assessed in randomised controlled trials (RCTs) and to compare them within a single evidence synthesis framework.
  
  
  METHODS
  A Bayesian network analysis method was used to generate direct and indirect comparisons while maintaining randomisation. The main outcomes were the proportion of ASAS20 patients at the follow-up of 12 weeks. The analysis was made based on an intention-to-treat basis.
  
  
  RESULTS
  Data were combined from 14 (RCTs) that included 17833 patients randomised to 7 treatment strategies, including placebo. Except for 3mg/kg infliximab at 0, 2, 6 weeks, all other treatments were demonstrated to be more effective than placebo in the terms of clinical index ASAS20. Compared with 25 mg etanercept twice a week, 50 mg etanercept once a week, 50 mg golimumab, 100 mg golimumab every four weeks, 5mg/kg infliximab at 0, 2, 6 weeks and 40 mg adalimumab every other week for 12 weeks seemed to be more effective (odds ratios [OR] 1.38, 1.22, 1.26, 1.29, 1.38, and 1.25, respectively), while etanercept 50 mg twice a week have the similar efficacy (odds ratios [OR] 1.08), and infliximab 3 mg/kg at 0, 2, 6 weeks was less effective (odds ratios [OR] 0.69). However, all of these between-treatment comparisons detected no significant analysis. Finally, ranking analysis suggested that infliximab 5 mg/kg at 0, 2, 6 weeks may be the best efficacious therapy.
  
  
  CONCLUSIONS
  Our results suggested that infliximab 5 mg/kg at 0, 2, 6 weeks seems to be the best efficacious therapy, while infliximab 3 mg/kg at 0, 2, 6 weeks maybe could not be considered in the future studies. Future studies could pay more attention to the comparison of different anti-TNF agents, instead of comparison between anti-TNF agents and placebo.
authors.affiliation: Orthopaedic Surgery Department, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. shutao5959@126.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Shu
authors.forename: Gui Hua
authors.initials: GH
authors.lastname: Chen
authors.forename: Limin
authors.initials: L
authors.lastname: Rong
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.forename: Bu
authors.initials: B
authors.lastname: Yang
authors.forename: Ruiqiang
authors.initials: R
authors.lastname: Chen
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001499:Bayes Theorem; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha