gms | German Medical Science

Background: RA is a chronic, systemic inflammatory disorder that, if inadequately treated, often progresses to joint destruction. Currently, patients are initially treated with conventional DMARDs; in patients with an inadequate response (IR), biologic DMARDs are often combined with MTX or other DMARDs to improve efficacy. We compared the relative efficacy and safety of abatacept versus all relevant biologic DMARDs in MTX-IR RA patients.

Methods: A systematic literature review identified randomized controlled trials (RCTs) investigating the efficacy and safety of abatacept subcutaneous (SC) and intravenous (IV), adalimumab, certolizumab, etanercept, infliximab, golimumab, tocilizumab and tofacitinib, with background MTX. Efficacy endpoints were ACR20/50/70 responses and DAS28 remission (DAS28≤2.6). Safety endpoints were incidence of serious adverse events (SAEs), infections and serious infections. Abatacept SC and IV were compared with tocilizumab and the combined group of anti-TNFs (adalimumab, certolizumab, etanercept, infliximab, golimumab). Results were analysed with Bayesian hierarchical network meta-analysis (NMA) models to estimate the relative efficacy and safety effects of biologic DMARDs. Although tofacitinib RCTs were identified in the literature search, they were not included in the NMA because the study population of the three tofacitinib RCTs was different to that of the other RCTs; most patients in the tofacitinib RCTs were previously exposed to biologic DMARDs, while patients in the other RCTs were naive to biologic DMARDs.

Results: The search was performed in October 2013, and 21 RCTs were included. Results indicate that abatacept SC has similar ACR20/50/70 response rates and DAS28 remission rates compared with other biologic DMARDs after 24 weeks of treatment (Table 1 [Tab. 1]). Similar efficacy results were found for abatacept IV (data not shown). Abatacept SC seems to have better safety versus tocilizumab and the combined anti-TNFs in terms of incidence of infections, serious infections and SAEs (Table 1 ); however, none of these differences were statistically significant. Similar results were found when comparing abatacept IV with tocilizumab and the combined anti-TNFs (data not shown).

Conclusion: Both abatacept SC and IV showed similar ACR20/50/70 and DAS28 remission rates compared to other biologic DMARDs in MTX-IR patients. Although not statistically significant, abatacept IV and SC tended to have slightly better safety outcomes compared with other biologic DMARDs.