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Biologics improved RA patients’ physical function after failure of other treatments
Biologic therapy was effective in improving physical function in patients with rheumatoid arthritis who had failed disease-modifying antirheumatic drug or anti-tumor necrosis factor treatments, according to study results.
Janet E. Pope, MD, MPH, FRCPC, professor of medicine and division head of rheumatology at St. Joseph’s Hospital and Schulich School of Medicine & Dentistry, University of Western Ontario, and colleagues conducted meta-analyses of 28 randomized, placebo-controlled trials involving patients with rheumatoid arthritis (RA). Mean difference in change in Health Assessment Questionnaire (HAQ) for biologic agent treatments compared with controls (dHAQB-dHAQC ) was the study outcome. Q-test based on analysis of variance was used to indirectly compare different biologic drugs, and meta-regression was performed.
Janet E. Pope
The studies included 19 with disease-modifying antirheumatic drug (DMARD; n=8,115) failures, four with anti-tumor necrosis factor (anti-TNF; n=1,694) failures and five involving early RA (n=2,492).
Abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab were biologics represented in the studies. Prior treatment significantly affected the efficacy of the biologics in reduction of HAQ (P=.001).
In patients with RA who experienced DMARD failures, dHAQB-dHAQC = -0.22 (95% CI, -0.24 to -0.20). There was a lower dHAQB-dHAQC for infliximab, abatacept and tocilizumab compared with other biologic treatments (P<.02). The dHAQB-dHAQC was –0.36 (95% CI, –0.42 to –0.30) in anti-TNF failures and –0.19 (95% CI, –0.26 to –0.13) in ERA, methotrexate-naïve studies.
“There were no significant differences in the efficacy of different biologics for anti-TNF failures and ERA,” the researchers reported.
“Biologics improve physical function in established RA patients failing DMARDs and anti-TNF agents,” the researchers concluded. “The mean improvement in HAQ at 6-12 months follow-up compared to DMARDs is at least the minimally clinically important difference for HAQ of 0.22. The role of biologic agents in improving HAQ in DMARD/methotrexate-naïve ERA is unclear. Future studies should confirm the differences with head-to-head comparisons.”
Disclosure: The researchers reported no relevant financial disclosures.