Tvete Ingunn Fride, Natvig Bent, Gåsemyr Jørund, Meland Nils, Røine Marianne, Klemp Marianne
The Norwegian Computing Center, Oslo, Norway.
Department of Mathematics, University of Oslo, Oslo, Norway.
PLoS One. 2015 Sep 10;10(9):e0137258. doi: 10.1371/journal.pone.0137258. eCollection 2015.
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.
类风湿性关节炎患者一直使用改善病情抗风湿药物(DMARDs)及更新的生物药物进行治疗。我们试图比较生物药物的疗效并进行排名。我们进行了文献检索,确定了54篇涵盖9种生物药物的出版物。我们进行了多重治疗比较回归分析,将美国风湿病学会(ACR)评分改善50%的人数作为因变量,剂量水平和病程作为自变量,以评估生物药物与安慰剂或DMARD之间的相对疗效。该分析纳入了所有出版物中的所有治疗组和对照臂。因此,任何生物制剂的所有测量效应都有助于所有生物制剂相互之间的比较,无论是单独使用还是与DMARD联合使用。我们发现药物疗效取决于剂量水平,而非病程,且高剂量与低剂量水平对所有药物的影响相同(更高剂量表明ACR50评分频率更高)。不与DMARD联合使用时,药物排名为赛妥珠单抗(排名最高)、依那西普、托珠单抗/阿巴西普和阿达木单抗。与DMARD联合使用时,药物排名为赛妥珠单抗(排名最高)、托珠单抗、阿那白滞素/利妥昔单抗、戈利木单抗/英夫利昔单抗/阿巴西普、阿达木单抗/依那西普[已修正]。不过,所有药物均有效。与安慰剂相比,所有生物制剂均有效,其中赛妥珠单抗最有效,阿达木单抗(未进行DMARD治疗时)和阿达木单抗/依那西普(与DMARD联合治疗时)最无效。一般来说,这些药物与DMARD联合使用时更有效,但依那西普除外。