Systematic Review and Meta-Analysis of the Efficacy and Safety of Existing TNF Blocking Agents in Treatment of Rheumatoid Arthritis

Kalle J. Aaltonen, Liisa M. Virkki, Antti Malmivaara, Yrjö T. Konttinen, Dan C. Nordström, Marja Blom

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background and Objectives:
Five-tumour necrosis factor (TNF)-blockers (infliximab, etanercept, adalimumab, certolizumab
pegol and golimumab) are available for treatment of rheumatoid arthritis. Only few clinical trials compare one TNF-blocker to another. Hence, a systematic review is required to indirectly compare the substances. The aim of our study is to estimate the efficacy and the safety of TNF-blockers in the treatment of rheumatoid arthritis (RA) and indirectly compare all five currently available blockers by combining the results from included randomized clinical trials (RCT).
Methods:
A systematic literature review was conducted using databases including: MEDLINE, SCOPUS (including EMBASE),
Cochrane library and electronic search alerts. Only articles reporting double-blind RCTs of TNF-blockers vs. placebo, with or without concomitant methotrexate (MTX), in treatment of RA were selected. Data collected were information of patients, interventions, controls, outcomes, study methods and eventual sources of bias.
Results:
Forty-one articles reporting on 26 RCTs were included in the systematic review and meta-analysis. Five RCTs studied
infliximab, seven etanercept, eight adalimumab, three golimumab and three certolizumab. TNF-blockers were more efficacious than placebo at all time points but were comparable to MTX. TNF-blocker and MTX combination was superior to either MTX or TNF-blocker alone. Increasing doses did not improve the efficacy. TNF-blockers were relatively safe compared to either MTX or placebo.
Conclusions
No single substance clearly rose above others in efficacy, but the results of the safety analyses suggest that
etanercept might be the safest alternative. Interestingly, MTX performs nearly identically considering both efficacy and safety aspects with a margin of costs.
Original languageEnglish
JournalPLoS One
Volume7
Issue number1
Pages (from-to)Article Number: e30275
Number of pages14
ISSN1932-6203
DOIs
Publication statusPublished - Jan 2012
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3121 Internal medicine

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