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Indirect comparison of anti-TNF-α agents for active ankylosing spondylitis: mixed treatment comparison of randomized controlled trials.

Abstract：

OBJECTIVES:We aimed to identify different anti-TNF-α agents for ankylosing spondylitis (AS) assessed in randomised controlled trials (RCTs) and to compare them within a single evidence synthesis framework. METHODS:A Bayesian network analysis method was used to generate direct and indirect comparisons while maintaining randomisation. The main outcomes were the proportion of ASAS20 patients at the follow-up of 12 weeks. The analysis was made based on an intention-to-treat basis. RESULTS:Data were combined from 14 (RCTs) that included 17833 patients randomised to 7 treatment strategies, including placebo. Except for 3mg/kg infliximab at 0, 2, 6 weeks, all other treatments were demonstrated to be more effective than placebo in the terms of clinical index ASAS20. Compared with 25 mg etanercept twice a week, 50 mg etanercept once a week, 50 mg golimumab, 100 mg golimumab every four weeks, 5mg/kg infliximab at 0, 2, 6 weeks and 40 mg adalimumab every other week for 12 weeks seemed to be more effective (odds ratios [OR] 1.38, 1.22, 1.26, 1.29, 1.38, and 1.25, respectively), while etanercept 50 mg twice a week have the similar efficacy (odds ratios [OR] 1.08), and infliximab 3 mg/kg at 0, 2, 6 weeks was less effective (odds ratios [OR] 0.69). However, all of these between-treatment comparisons detected no significant analysis. Finally, ranking analysis suggested that infliximab 5 mg/kg at 0, 2, 6 weeks may be the best efficacious therapy. CONCLUSIONS:Our results suggested that infliximab 5 mg/kg at 0, 2, 6 weeks seems to be the best efficacious therapy, while infliximab 3 mg/kg at 0, 2, 6 weeks maybe could not be considered in the future studies. Future studies could pay more attention to the comparison of different anti-TNF agents, instead of comparison between anti-TNF agents and placebo.

journal_name

Clin Exp Rheumatol

journal_title

Clinical and experimental rheumatology

authors

Shu T,Chen GH,Rong L,Feng F,Yang B,Chen R,Wang J

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

717-22

issue

eissn

0392-856X

issn

1593-098X

pii

6768

journal_volume

pub_type

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Indirect comparison of anti-TNF-α agents for active ankylosing spondylitis: mixed treatment comparison of randomized controlled trials.