title: Efficacy of biological agents administered as monotherapy in rheumatoid arthritis: a Bayesian mixed-treatment comparison analysis.
abstract: BACKGROUND
  Biological agents provide an important therapeutic alternative for rheumatoid arthritis patients refractory to conventional disease-modifying antirheumatic drugs. Few head-to-head comparative trials are available.
  
  
  OBJECTIVE
  The aim of this meta-analysis was to compare the relative efficacy of different biologic agents indicated for use as monotherapy in rheumatoid arthritis.
  
  
  METHODS
  A systemic literature search was performed on electronic databases to identify articles reporting double-blind randomized controlled trials investigating the efficacy of biologic agents indicated for monotherapy. Efficacy was assessed using American College of Rheumatology (ACR) 20, 50, and 70 criteria at 16-24 weeks. Relative efficacy was estimated using Bayesian mixed-treatment comparison models. Outcome measures were expressed as odds ratio and 95% credible intervals.
  
  
  RESULTS
  Ten randomized controlled trials were selected for data extraction and analysis. Mixed-treatment comparison analysis revealed that tocilizumab offered 100% probability of being the best treatment for inducing an ACR20 response versus placebo, methotrexate, adalimumab, or etanercept. Likewise, for ACR50 and ACR70 outcome responses, tocilizumab had a 99.8% or 98.7% probability of being the best treatment, respectively, compared to other treatments or placebo. Tocilizumab increased the relative probability of being the best treatment (vs methotrexate) by 3.2-fold (odds ratio: 2.1-3.89) for all ACR outcomes.
  
  
  CONCLUSIONS
  Tocilizumab offered the greatest possibility of obtaining an ACR20, ACR50, and ACR70 outcome vs other monotherapies or placebo.
authors.affiliation: Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Migliore
authors.affiliation: Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bizzi
authors.affiliation: Primula Multimedia SRL, Pisa, Italy.
authors.forename: Colin Gerard
authors.initials: CG
authors.lastname: Egan
authors.affiliation: Department of Statistical Sciences, University of Padova, Padova, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: MEMOTEF Department, Sapienza University of Rome, Rome, Italy.
authors.forename: Lea
authors.initials: L
authors.lastname: Petrella
keywords: biologics; meta-analysis; mixed-treatment comparison; monotherapy; rheumatoid arthritis; tocilizumab