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Anti-TNF comparison showed no significant differences in psoriatic arthritis treatment effectiveness
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A comparison of tumor necrosis factor-alpha inhibitors provided no significant differences in their effectiveness in treating patients with psoriatic arthritis, according to study results.
Researchers in Canada conducted a search of randomized clinical trials, systematic reviews and health technology assessments (HTAs) published on anti-tumor necrosis factor drugs (anti-TNFs) for psoriatic arthritis (PsA).
Researchers indirectly compared anti-TNFs, including adalimumab, etanercept, golimumab and infliximab, and measured RR for psoriatic arthritis response criteria (PsARC) and mean differences (MDs) in improvements for Health Assessment Questionnaire [HAQ] from baseline by PsARC responders and nonresponders. They also compared MD for improvements in psoriasis area and severity index (PASI). Conversions based on available data were performed when data for intervention group response rates and improvements were incomplete.
Data were gathered from 19 publications representing seven trials and two HTAs. While anti-TNFs were significantly better than controls for PsA treatment, indirect comparison of the anti-TNFs did not show any statistically significant differences. Golimumab provided the highest RR for PsARC response (RR=3.45; 95% CI, 2.39-4.99), followed by etanercept (RR=3.19; 95% CI, 2.31-4.42). Infliximab and adalimumab yielded smaller RRs (2.64 and 2.39, respectively).
Etanercept and infliximab displayed the largest MD among PsARC responders for HAQ improvements (0.43 and 0.41, respectively). Among PsARC nonresponders, etanercept, infliximab and golimumab provided similar MDs; adalimumab had a notably lower MD.
Infliximab displayed the largest MD for PASI improvement (6.44), followed by golimumab (4.90), with etanercept providing the smallest MD (2.13).
“Our indirect comparison did not demonstrate any significant difference between anti-TNF drugs for the treatment of PsA,” the researchers concluded. “In some instances, the magnitudes of effect in our indirect comparison differed from others. Since the analyzed outcomes play an important role informing quality adjusted life years (QALYs, and thus cost per QALY) in cost-effectiveness analyses, it seems reasonable to insist that the cost-effectiveness analyses on which the current drug indications are based be revised to check the robustness of their findings.”
Disclosure: See the study for a full list of relevant disclosures.
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