Network Meta‐Analysis of Tofacitinib versus Biologic Treatments in Moderate‐to‐Severe Rheumatoid Arthritis Patients
This study suggests that many bDMARDs and tsDMARDs can be considered equivalent therapeutic alternatives in bDMARD-naïve RA patients, with inadequate response to csDMARDs.
In the absence of randomised controlled trials comparing drugs, indirect comparisons and network meta-analysis may provide information to help select an optimal treatment alternative. In this network meta-analysis, 27 randomized controlled trials were analysed to assess the possibility that some drugs on the market may be considered to be equivalent in terms of efficacy. Only trials reporting ACR50 at Week 24 and with a placebo-controlled arm were included. The therapies investigated in the final meta-analysis were: abatacept, adalimumab, anakinra, baricitinib, certolizumab, etanercept, golimumab, infliximab, tocilizumab, and tofacitinib.
In the primary analysis, the response of each treatment was evaluated against placebo plus methotrexate. The potential for equivalence therapeutic alternative (ETA) was then assessed with between-drug comparisons. The treatment with the highest response was etanercept in combination with methotrexate; however, there was a large 95% CI for this data point, possibly reflecting the small sample size. The ETA methodology was applied by comparing differences in ACR50 at Week 24 for etanercept plus methotrexate, but none of the other medications presented a difference in the response less than the previously established range (12%), and therefore did not meet the criteria to be considered ETA to etanercept plus methotrexate. Comparisons were then made to the next best-performing drug in efficacy - certolizumab plus methotrexate.
In this second analysis, the authors were able to conclude that all the remaining drug combinations conformed to efficacy criteria and could be considered ETA to certolizumab plus methotrexate, with the exception of adalimumab or tofacitinib when given as monotherapy, or anakinra in combination with methotrexate.