Publications

Treatment options for RA patients who are MTX/DMARD incomplete responders (IR) include other DMARDs, biologics or tofacitinib (TOF). However, there is a lack of direct head-to-head comparator trials of biologics in people with RA. This review provides an update of the 2009 Cochrane overview, ‘Biologics for rheumatoid arthritis’,1 and provides comparisons and estimates for biologic or TOF monotherapy in MTX/DMARD-IR people with RA.The benefits and harms of biologic monotherapy (TNFis: adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or non-TNF (abatacept, anakinra, rituximab, tocilizumab), or TOF monotherapy were assessed versus placebo or MTX/DMARDs (active comparator). The review included randomised controlled trials (RCTs) from The Cochrane Central Register of Controlled Trials (CENTRAL) (via The Cochrane Library Issue 6, June 2015), MEDLINE (1946 to June 2015) and EMBASE (1947 to June 2015). This update includes data from 41 RCTs (14,049 patients).Similar and statistically significant and clinically relevant improvements were seen in: ACR50 with TOF monotherapy, TNF biologic and non-TNF biologic monotherapy versus placebo; HAQ score with TOF monotherapy, TNF biologic and anakinra versus placebo (no data available for non-TNF). Biologic monotherapy showed greater remission versus placebo, and improvements in ACR50, HAQ score, remission and radiographic progression versus MTX/other DMARDs. However, these data were not available for comparison with TOF monotherapy.Results were inconclusive for whether biologic monotherapy was associated with an increased risk of withdrawals due to AEs, SAEs or cancer versus placebo (no data on cancer) or MTX/other DMARDs. 1. Singh JA, et al. Cochrane Database Syst Rev 2009: CD007848. doi: 10.1002/14651858.CD007848.