Effectiveness of biologic therapies for XXXX : an indirect comparisons approach.

@entity1 @entity23 @entity2408 @entity1499 @entity309
STUDY OBJECTIVE: To compare the efficacy of biologic disease-modifying antirheumatic drugs (DMARDs) versus placebo with or without @entity1499 , in treating @entity309 . DESIGN: Comparative effectiveness analysis using an indirect treatment comparison (ITC) method in a Bayesian framework. @entity1 : Adults with @entity309 who had been enrolled in @entity23 ( @entity23 ) and had never failed biologic DMARD therapy. MEASUREMENTS AND MAIN RESULTS: Two random-effects logistic regression models, representing 6 and 12 months of treatment, were created using @entity23 identified in a literature search. Twenty-three @entity23 (11,589 @entity1 ) were included in the 6-month model and 10 @entity23 (6051 @entity1 ) in the 12-month model. Nine biologic DMARDs in five therapeutic drug classes were included in the 6-month model, and six biologic DMARDs in three classes were included in the 12-month model. Our efficacy end point was the American College of Rheumatology 50% improvement criteria. In the 6-month model, all biologic DMARDs and @entity1499 were significantly more efficacious than placebo and ranked in the following order: certolizumab (median log odds ratio [OR] 2.6), tocilizumab (1.7), rituximab (1.6), infliximab (1.6), etanercept (1.4), adalimumab (1.4), golimumab (1.4), abatacept (1.2), anakinra (1.0), and @entity1499 (0.8). Of 45 pairwise comparisons, certolizumab was significantly more efficacious than @entity1499 , but no other comparisons were significant. The rank order in the 12-month analysis was certolizumab (median log OR 2.0), @entity2408 (2.0), adalimumab (1.4), infliximab (1.4), etanercept (0.9), abatacept (0.6), and @entity1499 (0.8). Of the 21 pairwise comparisons, none were significant. The results of the model using therapeutic class revealed that each class was more efficacious than placebo. In pairwise comparisons, each class was more efficacious than @entity1499 , but none was more efficacious than another. CONCLUSION: Use of emerging ITC methods enabled us to compare the efficacy of biologic DMARDs for the treatment of @entity309 in the absence of direct head-to-head comparison trials. Our methods enabled us to rank order these treatments. Further analyses by drug and by therapeutic class suggest that biologic DMARDs are similarly efficacious.
