Tofacitinib, Etanercept and Rituximab are the highest probability drugs of inciting an ACR50 or ACR70 responses at 12 months in the early stage of the disease (ERA) patients.
As per the findings of the Bayesian
present mixed treatment comparisons (MTCs) published in 'Clinical Rheumatology',
Tofacitinib, Etanercept and Rituximab are the highest probability drugs of
inducing an ACR50 or ACR70 responses at 12 months in the early stage of the
disease (ERA) patients with disease duration <1 year.
The present paradigm in rheumatoid
arthritis (RA) management is to treat patients in the ERA. Earlier
meta-analysis-based MTCs, focused on identifying the most effective drugs in
ERA, which are biased by the broad "window" of early definition,
varying from 6 months to 2 years. In this study, Vincenzo Venerito et al. aimed
to evaluate through a Bayesian Network Meta-Analysis that which biologics or
small molecules are more likely to attain a 1-year good clinical response in
ERA patients with disease duration < 1 year.
Randomized controlled trials (RCTs) of biologic agents and small molecules in
combination with MTX to treat patients affected with ERA lasting < 1 year
were searched using EMBASE, MEDLINE, Cochrane Library, and Clinicaltrials.gov
between the year 1990 and September 2017 as per the Preferred Reporting Items
for Systematic Reviews and Meta-analyses statement. At 1 year, the outcome of
interest was the achievement of the American College of Rheumatology (ACR) 50
and ACR 70 response. Using a fixed-effect model, WinBUGS 1.4 software was used
for assessment. Total of 14 studies was considered in this analysis.
Tofacitinib (64.83%) and then, Etanercept (23.26%) had the highest probability
of achieving the ACR50 response. Rituximab depicted the highest likelihood of
inducing ACR70 response (52.81%) and followed by Etanercept (26.85%).
The study authors concluded,
"Further RCTs, possibly considering head-to-head comparisons and involving
radiological along with clinical outcomes, on RA patients with accurate time
definition of early disease are awaited."
Clinical Rheumatology
A Bayesian mixed treatment comparison of efficacy of biologics and small molecules in early rheumatoid arthritis
Vincenzo Venerito et al.
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