The Korean journal of internal medicine

  • 제32권3호
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  • Pages.536-547
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  • 2017
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Comparative efficacy of biological agents in methotrexate-refractory rheumatoid arthritis patients: a Bayesian mixed treatment comparison

  • Choi, Miyoung (National Evidence-Based Healthcare Collaboration Agency (NECA)) ;
  • Hyun, Min Kyung (Department of Preventive Medicine, Dongguk University College of Korean Medicine) ;
  • i Choi, Seongm (Korea Appraisal Board, Real Estate R&D Institute) ;
  • Tchoe, Ha Jin (National Evidence-Based Healthcare Collaboration Agency (NECA)) ;
  • Lee, Sung Yeon (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Son, Kyeong Min (Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital) ;
  • Kim, Min-Jeong (National Evidence-Based Healthcare Collaboration Agency (NECA)) ;
  • Jung, Young Ok (Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Kim, Hyun Ah (Department of Internal Medicine, Hallym University Sacred Heart Hospital)
  • 투고 : 2015.05.13
  • 심사 : 2015.06.26
  • 발행 : 2017.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Biological agents (biologics) targeting proinflammatory signaling have emerged as an important treatment option in rheumatoid arthritis (RA). Despite the clinical effectiveness of biologics for patients with RA who do not respond to 'traditional' disease-modifying anti-rheumatic drugs (DMARDs), there are concerns regarding their cost and long-term safety. In this study, we aimed to compare the efficacy of various biologics and traditional DMARDs in RA patients refractory to methotrexate (MTX). Methods: Four DMARDs (hydroxychloroquine, sulfasalazine, MTX, lef lunomide) and five anti-tumor necrosis factor drugs (adalimumab, etanercept, golimumab, infliximab, and certolizumab) were selected. A systematic search of published studies was performed from inception through July 2013. Randomized trials of adults with MTX-refractory RA comparing two or more of the selected medications were included. Among 7,938 titles identified, in total, 16 head-to-head trials were selected. Two reviewers independently abstracted the study data and assessed methodological quality using the Cochrane Risk of Bias. Comparative efficacy was analyzed using a Bayesian mixed treatment comparison (MTC). Results: In total, 9, 4, and 11 studies were included for the outcome measures of the Health Assessment Questionnaire (HAQ), Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) < 2.6 (remission), and American College of Rheumatology (ACR) 70 response, respectively. The treatments with the highest efficacy for each outcome measure were certolizumab combined with MTX, golimumab combined with MTX, and certolizumab combined with MTX, respectively. Conclusions: Based on MTC analysis, using data from published randomized controlled trials, certolizumab and golimumab combined with MTX showed the highest efficacy in the three outcome measures (HAQ, DAS28-ESR < 2.6, and ACR 70 response) in MTX-refractory RA patients.

키워드

과제정보

연구 과제 주관 기관 : National Evidence-based Healthcare Collaborating Agency (NECA), Ministry of Health and Welfare

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피인용 문헌

  1. The Efficacy and Safety of Mainstream Medications for Patients With cDMARD-Naïve Rheumatoid Arthritis: A Network Meta-Analysis vol.9, pp.None, 2017, https://doi.org/10.3389/fphar.2018.00138
  2. First line of biological drugs in rheumatoid arthritis: a medication persistence analysis vol.12, pp.4, 2017, https://doi.org/10.1080/17512433.2019.1586533
  3. The Use of Biological Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in Korea: Results of a Korean Expert Consensus vol.27, pp.1, 2017, https://doi.org/10.4078/jrd.2020.27.1.4