Comparative efficacy and safety of biologic agents in patients with active rheumatoid arthritis and inadequate response to tumor necrosis factor inhibitors: A Bayesian network meta-analysis of randomized controlled trials.

医学 托珠单抗 阿巴塔克普 类风湿性关节炎 不利影响 美罗华 内科学 托法替尼 安慰剂 随机对照试验 肿瘤坏死因子抑制剂 塞库金单抗 药理学 阿达木单抗 银屑病性关节炎 淋巴瘤 病理 替代医学
作者
Yoon‐Kyoung Sung,Young Ho Lee
出处
期刊:International Journal of Clinical Pharmacology and Therapeutics [Dustri-Verlag]
卷期号:60 (1): 13-23 被引量:1
标识
DOI:10.5414/cp204036
摘要

This study aimed to evaluate the relative efficacy and safety of biologic agents in patients with rheumatoid arthritis (RA) who show inadequate response to tumor necrosis factor (TNF) inhibitors.A meta-analysis with the Bayesian network, combining direct and indirect randomized controlled trial (RCT) data, was conducted to examine the efficacy and safety of abatacept, rituximab, tocilizumab, sarilumab, sirukumab, and secukinumab in patients with RA who showed inadequate response to TNF inhibitors.8 RCTs enrolling a total of 3,617 patients fulfilled the inclusion criteria. More significant American College of Rheumatology 20% (ACR20), ACR50, and ACR70 responses were obtained using therapies similar to these biologics than with placebo. Ranking probability based on surface under the cumulative ranking curve (SUCRA) indicated that tocilizumab was probably the best treatment for ACR20 response, followed by rituximab, abatacept, sarilumab, sirukumab, secukinumab 150 mg, secukinumab 75 mg, and placebo. Furthermore, identical distribution trends were observed for ACR50 response rates. In comparison, ACR70-based SUCRA rating revealed that rituximab, followed by tocilizumab, abatacept, sirukumab, secukinumab 150 mg, sarilumab, secukinumab 75 mg, and placebo might potentially result in ACR70. There was no significant difference between the number of adverse events and severe adverse events between the treatments.All biologic agents studied were effective in treating patients with TNF inhibitor-refractory RA; however, tocilizumab, rituximab, and abatacept appeared to be more efficient than sarilumab, sirukumab, and secukinumab. There were no differences between the treatments with respect to safety.
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