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Minor differences in efficacy between biologics for rheumatoid arthritis

In patients with rheumatoid arthritis who have failed to achieve sufficient control with methotrexate, there are few important differences between second-line biologic treatments.

This is according to a systematic review and meta-analysis by a team from Cologne, Germany.

The researchers included a network meta-analysis that allowed for comparison of treatments that were not studied directly in head-to-head trials and also contacted market authorisation holders for unpublished studies and any additional but unpublished data from studies.

This provided a huge amount of information for analysis at the individual patient level. Data was analysed only from randomised controlled trials in adults who were treated with methotrexate combined with a biologic agent for at least 24 weeks.

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A total of 38 trials were included in the final analysis although only 34 trials (with nearly 11,000 patients) covering eight different biologics provided data on clinical remission. The authors reported that overall, the analysis revealed few statistically significant differences in terms of benefits and harms between the biologics. However, some differences were detected, for instance, anakinra was the least effective biologic and certolizumab showed the most harm.

Commenting on their findings, the authors noted that though biologics have been available for many years, there was a lack of both comparative studies and long-term data such that they could only derive conclusions of low certainty.

Janke K et al. Comparative effectiveness of biological medicines in rheumatoid arthritis: systematic review and network meta-analysis including aggregate results from re-analaysed individual patient data. BMJ 2020;370:m2288 bmj.m2288.