Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis

a systematic review and meta-analysis

Patompong Ungprasert, Patricia J. Erwin, Matthew Koster

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Patients with ankylosing (AS) often do not have a satisfactory response to, or could not tolerate, non-steroidal anti-inflammatory drugs (NSAIDs). Several biologic agents are available for such patients. However, the comparative efficacy of these treatments remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of biologic agents in patients with AS who had inadequate response to, or could not tolerate, NSAIDs were identified. If at least two RCTs were available for a given biologic agent, the pooled odds ratio (OR) and 95% confidence interval (CI) of achieving 20% improvement according to the Ankylosing Spondylitis Assessment Study group response criteria 20 (ASAS20) across trials were calculated. The pooled OR for each biologic agent was then compared to each other using the indirect comparison technique. A total of 14 RCTs of older TNF inhibitors, two RCTs of secukinumab, one RCT of certolizumab, and one RCT of tofacitinib were identified. No significant difference in any indirect comparisons was observed with the p values ranging from 0.12 to 0.74. The likelihood of achieving the ASAS20 response in patients AS who failed or could not tolerate NSAIDs was not significantly different between older TNF inhibitors, secukinumab, certolizumab, and tofacitinib. However, the analysis is limited by the small sample size with only one RCT for certolizumab and tofacitinib.

Original languageEnglish (US)
Pages (from-to)1569-1577
Number of pages9
JournalClinical Rheumatology
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Ankylosing Spondylitis
Biological Factors
Meta-Analysis
Randomized Controlled Trials
Anti-Inflammatory Agents
Odds Ratio
Pharmaceutical Preparations
Sample Size
Confidence Intervals

Keywords

  • Ankylosing spondylitis
  • Biologic agents
  • Meta-analysis
  • Systematic review
  • TNF inhibitors

ASJC Scopus subject areas

  • Rheumatology

Cite this

Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis : a systematic review and meta-analysis. / Ungprasert, Patompong; Erwin, Patricia J.; Koster, Matthew.

In: Clinical Rheumatology, Vol. 36, No. 7, 01.07.2017, p. 1569-1577.

Research output: Contribution to journalArticle

@article{031df6f11b524e5c9ab433d14cfe89f9,
title = "Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis: a systematic review and meta-analysis",
abstract = "Patients with ankylosing (AS) often do not have a satisfactory response to, or could not tolerate, non-steroidal anti-inflammatory drugs (NSAIDs). Several biologic agents are available for such patients. However, the comparative efficacy of these treatments remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of biologic agents in patients with AS who had inadequate response to, or could not tolerate, NSAIDs were identified. If at least two RCTs were available for a given biologic agent, the pooled odds ratio (OR) and 95{\%} confidence interval (CI) of achieving 20{\%} improvement according to the Ankylosing Spondylitis Assessment Study group response criteria 20 (ASAS20) across trials were calculated. The pooled OR for each biologic agent was then compared to each other using the indirect comparison technique. A total of 14 RCTs of older TNF inhibitors, two RCTs of secukinumab, one RCT of certolizumab, and one RCT of tofacitinib were identified. No significant difference in any indirect comparisons was observed with the p values ranging from 0.12 to 0.74. The likelihood of achieving the ASAS20 response in patients AS who failed or could not tolerate NSAIDs was not significantly different between older TNF inhibitors, secukinumab, certolizumab, and tofacitinib. However, the analysis is limited by the small sample size with only one RCT for certolizumab and tofacitinib.",
keywords = "Ankylosing spondylitis, Biologic agents, Meta-analysis, Systematic review, TNF inhibitors",
author = "Patompong Ungprasert and Erwin, {Patricia J.} and Matthew Koster",
year = "2017",
month = "7",
day = "1",
doi = "10.1007/s10067-017-3693-7",
language = "English (US)",
volume = "36",
pages = "1569--1577",
journal = "Clinical Rheumatology",
issn = "0770-3198",
publisher = "Springer London",
number = "7",

}

TY - JOUR

T1 - Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis

T2 - a systematic review and meta-analysis

AU - Ungprasert, Patompong

AU - Erwin, Patricia J.

AU - Koster, Matthew

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Patients with ankylosing (AS) often do not have a satisfactory response to, or could not tolerate, non-steroidal anti-inflammatory drugs (NSAIDs). Several biologic agents are available for such patients. However, the comparative efficacy of these treatments remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of biologic agents in patients with AS who had inadequate response to, or could not tolerate, NSAIDs were identified. If at least two RCTs were available for a given biologic agent, the pooled odds ratio (OR) and 95% confidence interval (CI) of achieving 20% improvement according to the Ankylosing Spondylitis Assessment Study group response criteria 20 (ASAS20) across trials were calculated. The pooled OR for each biologic agent was then compared to each other using the indirect comparison technique. A total of 14 RCTs of older TNF inhibitors, two RCTs of secukinumab, one RCT of certolizumab, and one RCT of tofacitinib were identified. No significant difference in any indirect comparisons was observed with the p values ranging from 0.12 to 0.74. The likelihood of achieving the ASAS20 response in patients AS who failed or could not tolerate NSAIDs was not significantly different between older TNF inhibitors, secukinumab, certolizumab, and tofacitinib. However, the analysis is limited by the small sample size with only one RCT for certolizumab and tofacitinib.

AB - Patients with ankylosing (AS) often do not have a satisfactory response to, or could not tolerate, non-steroidal anti-inflammatory drugs (NSAIDs). Several biologic agents are available for such patients. However, the comparative efficacy of these treatments remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of biologic agents in patients with AS who had inadequate response to, or could not tolerate, NSAIDs were identified. If at least two RCTs were available for a given biologic agent, the pooled odds ratio (OR) and 95% confidence interval (CI) of achieving 20% improvement according to the Ankylosing Spondylitis Assessment Study group response criteria 20 (ASAS20) across trials were calculated. The pooled OR for each biologic agent was then compared to each other using the indirect comparison technique. A total of 14 RCTs of older TNF inhibitors, two RCTs of secukinumab, one RCT of certolizumab, and one RCT of tofacitinib were identified. No significant difference in any indirect comparisons was observed with the p values ranging from 0.12 to 0.74. The likelihood of achieving the ASAS20 response in patients AS who failed or could not tolerate NSAIDs was not significantly different between older TNF inhibitors, secukinumab, certolizumab, and tofacitinib. However, the analysis is limited by the small sample size with only one RCT for certolizumab and tofacitinib.

KW - Ankylosing spondylitis

KW - Biologic agents

KW - Meta-analysis

KW - Systematic review

KW - TNF inhibitors

UR - http://www.scopus.com/inward/record.url?scp=85019725427&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019725427&partnerID=8YFLogxK

U2 - 10.1007/s10067-017-3693-7

DO - 10.1007/s10067-017-3693-7

M3 - Article

VL - 36

SP - 1569

EP - 1577

JO - Clinical Rheumatology

JF - Clinical Rheumatology

SN - 0770-3198

IS - 7

ER -