Session Type: Abstract Submissions (ACR)
The Health Assessment Questionnaire (HAQ) is a patient-centred, validated measure of physical function. It is predictive for disability, morbidity and mortality. The efficacy of various biologics agents for improving HAQ in patients with Rheumatoid arthritis (RA) has been demonstrated in numerous trials. However, head-to-head comparisons of biologic agents are scarce. The objective of this study was to determine the comparative efficacy of biologic agents for improving HAQ in patients with established RA who failed Disease Modifying Anti-Rheumatic Drugs (DMARDs) or anti-Tumour Necrosis Factor alpha (TNF) agents and in patients with early RA (ERA).
Methods: We performed random effects meta-analyses (Mantel-Haenszel method) of randomized, placebo-controlled trials. Inclusion criteria were: age >15 years, clinically utilized biologic agents, HAQ score at baseline and 6 or 12 months. We searched PubMed, EMBASE and the Cochrane Library. Outcome was the mean difference in change in HAQ for biologic agents compared to controls (DHAQB–DHAQC). Indirect comparisons of the different biologic drugs compared to the control group were conducted using the Q-test based on analysis of variance. Meta-regression was performed using the method of moments.
31 trials were included: 23 with DMARD-failures; 5 with anti-TNF-failures and 6 ERA. The following biologics were represented: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab. In established RA patients with DMARD failures: DHAQB–DHAQC = -0.28; 95%CI:-0.324, -0.237 (I2=64%); abatacept and infliximab were less effective compared to the other anti-TNF agents and tocilizumab (p<0.01). In anti-TNF-failures: DHAQB–DHAQC was -0.254; 95%CI: -0.46, -0.049 (I2=92%); golimumab was not effective compared to control and abatacept was superior to tocilizumab (p=0.0184); rituximab was equivalent to abatacept and tocilizumab. Heterogeneity was predominately due to differences in the efficacy of the different biologic agents. In ERA trials: DHAQB–DHAQC = -0.231; 95% CI: -0.323, -0.14 (I2=0%); adalimumab, etanercept, infliximab and rituximab were equally effective. Using meta-regression, baseline HAQ did not significantly effect HAQ improvement.
Biologic agents were efficacious at lowering HAQ in established RA and ERA by at least the minimally clinically important difference of 0.22. However, infliximab and abatacept were less effective in DMARD-failures. The role of anti-TNF agents in anti-TNF failures and of biologics in DMARD-naïve patients remains unclear.
L. J. Barra,
J. E. Pope,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-different-biologic-agents-for-improving-physical-function-as-measured-by-the-health-assessment-questionnaire-a-meta-analysis-with-indirect-comparisons/