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Researchers still undecided over which biologics work best for rheumatoid arthritis
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Most clinical researchers are convinced that biologic drugs have a positive impact on rheumatoid arthritis (RA), but more studies directly comparing the effectiveness of different drugs are needed, according to Cochrane Researchers.
The researchers compared all previous Cochrane Systematic Reviews, assessing the effectiveness of biologic disease-modifying drugs for the treatment of RA. Although all medications were found to be very effective, the studies produced few data that could help physicians decide which biologics to prescribe, according to a press release.
In recent years, biologic disease-modifying anti-rheumatic drugs (DMARDs) have been introduced that can help to modify this irregular immune response and improve symptoms of the disease. Although these new drugs may have fewer side effects than traditional DMARDs such as methotrexate, they are more expensive, lead researcher Jasvinder Singh, PhD, said in the press release.
The six previous reviews considered by the researchers used two measures to make indirect comparisons between different biologic drugs. The first was a physician or patient assessment of symptoms including the number of swollen joints.
The researchers saw an increase of at least 40% in the number of people experiencing improved symptoms when adalimumab (Humira, Abbott), etanercept (Enbrel, Amgen) and rituximab (Rituxen, Genentech) were compared to placebos. Anakinra (Kineret, Amgen), another biologic, was the least effective, demonstrating just 6% improvement compared to placebos, according to the press release.
The second measure was the number of people who dropped out of studies due to adverse effects. Fewer than 10% of the patients dropped out in most cases; however, etanercept, abatacept and infliximab seemed to be responsible for the fewest withdrawals, he said in the press release.
“Doctors are faced with a difficult dilemma when choosing biologics to prescribe to RA patients. Although anakinra seemed less effective in the trials we looked at, we did not have any data from direct comparisons between different drugs,” said Singh, who is based at the Minneapolis Veterans Affairs Medical Center.
Ultimately, “We believe that direct head-to-head comparisons of biologic drugs in patients suffering from RA are needed. These trials should examine efficacy and safety at different stages and severity levels of the disease, as well as prior treatment with other drugs,” he said in the press release.