Conventional DMARDs 치료에 실패한 류마티스 관절염 환자에서 Biologic DMARDs의 임상적 효과 비교: 베이지안 네트워크 메타분석
Comparative Effectiveness of Biologic DMARDs in Rheumatoid Arthritis Patients with Inadequate Response to conventional DMARDs: Using a Bayesian Network Meta-analysis
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초록
Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritispatients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacycompared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. Theobjective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab withconventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under thecondition of the reimbursement coverage criteria in Korea. Methods: A systematic review was conducted using MEDLINE andCochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesianoutcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR wasgreater than one. Results: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR responserates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) forGolimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. InACR50 and ACR70, the ORs did not present significant differences. Conclusion: Certolizaumab with cDMARD was more effective orcomparable than other bDMARDs in patients who failed prior cDMARD treatment.
Abstract
Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritispatients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacycompared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. Theobjective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab withconventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under thecondition of the reimbursement coverage criteria in Korea. Methods: A systematic review was conducted using MEDLINE andCochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesianoutcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR wasgreater than one. Results: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR responserates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) forGolimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. InACR50 and ACR70, the ORs did not present significant differences. Conclusion: Certolizaumab with cDMARD was more effective orcomparable than other bDMARDs in patients who failed prior cDMARD treatment.
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