title: Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis.
abstract: Rheumatoid arthritis patients have been treated with disease modifying anti-rheumatic drugs (DMARDs) and the newer biologic drugs. We sought to compare and rank the biologics with respect to efficacy. We performed a literature search identifying 54 publications encompassing 9 biologics. We conducted a multiple treatment comparison regression analysis letting the number experiencing a 50% improvement on the ACR score be dependent upon dose level and disease duration for assessing the comparable relative effect between biologics and placebo or DMARD. The analysis embraced all treatment and comparator arms over all publications. Hence, all measured effects of any biologic agent contributed to the comparison of all biologic agents relative to each other either given alone or combined with DMARD. We found the drug effect to be dependent on dose level, but not on disease duration, and the impact of a high versus low dose level was the same for all drugs (higher doses indicated a higher frequency of ACR50 scores). The ranking of the drugs when given without DMARD was certolizumab (ranked highest), etanercept, tocilizumab/ abatacept and adalimumab. The ranking of the drugs when given with DMARD was certolizumab (ranked highest), tocilizumab, anakinra/rituximab, golimumab/ infliximab/ abatacept, adalimumab/ etanercept [corrected]. Still, all drugs were effective. All biologic agents were effective compared to placebo, with certolizumab the most effective and adalimumab (without DMARD treatment) and adalimumab/ etanercept (combined with DMARD treatment) the least effective. The drugs were in general more effective, except for etanercept, when given together with DMARDs.
authors.affiliation: The Norwegian Computing Center, Oslo, Norway.
authors.forename: Ingunn Fride
authors.initials: IF
authors.lastname: Tvete
authors.affiliation: Department of Mathematics, University of Oslo, Oslo, Norway.
authors.forename: Bent
authors.initials: B
authors.lastname: Natvig
authors.affiliation: Department of Mathematics, University of Oslo, Oslo, Norway.
authors.forename: Jørund
authors.initials: J
authors.lastname: Gåsemyr
authors.affiliation: Smerud Medical Research International AS, Oslo, Norway.
authors.forename: Nils
authors.initials: N
authors.lastname: Meland
authors.affiliation: Smerud Medical Research International AS, Oslo, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Røine
authors.affiliation: Department of Pharmacology, University of Oslo, Oslo, Norway; The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Klemp
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D006801:Humans; D011336:Probability; D012044:Regression Analysis
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors