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TNF inhibitors perform similarly in ankylosing spondylitis
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In a study of six TNF inhibitors, infliximab demonstrated early superiority in treating ankylosing spondylitis, but the benefit faded at 24 weeks, leaving little difference between any of the therapies, according to findings published in the Journal of Rheumatology.
“Several TNF inhibitors are available for symptom control in patients with ankylosing spondylitis (AS),” Runsheng Wang, MD, MHS, of the Columbia University College of Physicians and Surgeons, told Healio Rheumatology. “A question that naturally arises during clinical encounter is whether any TNF inhibitor is more efficacious than others.”
To compare different TNF inhibitors in the treatment of AS at 12 and 24 weeks, the researchers conducted a systematic review and network meta-analysis of 20 randomized controlled trials. The studies included analyses of six TNF inhibitors, representing 43 treatment arms and 3,220 patients.
Clinical trials included in the review reported efficacy at 10 to 14 weeks, as well as at 24 to 30 weeks, allowing for 12- and 24-week analyses. The researchers used a Bayesian network meta-analysis to compare the therapies’ relative efficacy in improving participants’ Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and C-reactive protein level.
According to the researchers, all analyzed TNF inhibitors were significantly better than placebo at reducing BASDAI and BASFI at 12 and 24 weeks. However, all but certolizumab pegol were statistically better than placebo in reducing C-reactive protein at 12 weeks. In addition, all but certolizumab pegol and infliximab-dyyb, an infliximab (Remicade, Janssen) biosimilar, were significantly better than placebo at reducing C-reactive protein at 24 weeks. Although infliximab resulted in greater decreased BASDAI at 12 weeks compared with the other TNF inhibitors, this benefit did not extend to 24 weeks. Except for one single open-label trial, there were no differences among TNF inhibitors, the researchers wrote.
“Limited by the small number of head-to-head comparison of different TNF inhibitors, our results indicated that all TNF inhibitors performed similarly,” Wang said. “There was a slight advantage for infliximab early, but no difference was seen at 6 months. Our results suggested that we need more comparative effective trials on relative short-term and long-term effectiveness and safety of TNF inhibitors to provide guidance in the treatment of AS in clinical practice.” – by Jason Laday
Disclosure: The researchers report funding from the Intramural Research Program, NIAMS and NIH.
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