title: Comparative Efficacy and Acceptability of Anti-TNF-Alpha Therapy in Ankylosing Spondylitis: A Mixed-Treatments Comparison.
abstract: BACKGROUND
  Tumor necrosis factor α (TNFα) antagonists, namely, golimumab, adalimumab, infliximab, etanercept and certolizumab have been prescribed to alleviate and treat ankylosing spondylitis (AS). However, the lack of comparative evidence does not enable us to make constructive recommendations particularly for AS patient populations.
  
  
  METHODS
  Eligible controlled trials regarding the above 5 anti-TNFα therapies were searched electronically through PubMed, Embase and Cochrane until April 1, 2015. Odds ratios (ORs) were estimated and compared for efficacy (ASAS20, ASAS40, ASAS5/6 responses and ASAS partial remission) and acceptability (serious adverse effects (SAE)) among the anti-TNFα reagents.
  
  
  RESULTS
  Totally, 25 trials with 2989 participants were incorporated in this mixed treatment comparison. All the 5 TNFα blockers achieved better ASAS20, ASAS40, ASAS5/6 and ASAS-PR responses than the placebo. Furthermore, there was no significant distinction existed among inter-drug comparisons, except that unfavorable effects induced by certolizumab seemed to be less severe than those by etanercept (OR = 0.22, 95% CI: 0.05-0.93). Apart from that, etanercept was estimated to arrive at the most favorable ASAS20 response (90.6%) and SAE (83.6%), while infliximab seemed to accomplish the best ASAS40 (83.6%) and ASAS-PR responses (77.3%). In addition, adalimumab was estimated to rank the highest ASAS5/6 response (75.0%).
  
  
  CONCLUSIONS
  Etanercept, infliximab and adalimumab might be prioritized among the commonly recognized 5 anti-TNFα therapies specific for AS patients, though existing evidence did not suffice to confirm significant superiority among the above 5 anti-TNFα reagent.
authors.affiliation: Department of Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China.
authors.forename: Yehua
authors.initials: Y
authors.lastname: Wang
authors.forename: Haibo
authors.initials: H
authors.lastname: Wang
authors.forename: Jian
authors.initials: J
authors.lastname: Jiang
authors.forename: Deyong
authors.initials: D
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000068582:Certolizumab Pegol / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D000068800:Etanercept / Q000627:therapeutic use*; D015870:Gene Expression; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D016017:Odds Ratio; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000235:genetics / Q000276:immunology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol