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Meta-Analysis
. 2015 Sep 10;10(9):e0137258.
doi: 10.1371/journal.pone.0137258. eCollection 2015.

Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis

Ingunn Fride Tvete  1 , Bent Natvig  2 , Jørund Gåsemyr  2 , Nils Meland  3 , Marianne Røine  3 , Marianne Klemp  4
Affiliations
Meta-Analysis

Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis

Ingunn Fride Tvete et al. PLoS One. .

Erratum in

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart.
Study selection procedure.
Fig 2
Fig 2. Direct and indirect comparisons.
DM indicates either DMARD alone or placebo and DMARD treatment together.
Fig 3
Fig 3. Histograms and ranking I.
ACR50 effects as the response ratio versus placebo, drugs given alone.
Fig 4
Fig 4. Histograms and ranking II.
ACR50 effects as the response ratio versus placebo, drugs were given together with DMARD.
See this image and copyright information in PMC

References

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