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Front. Pharmacol. | doi: 10.3389/fphar.2018.00138

The efficacy and safety of mainstream medications for patients with cDMARD-naïve rheumatoid arthritis: a network meta-analysis

Weiyan Cai1, Youyi Gu1, Huanqin Cui1, Yinyin Cao1, Xiaoliang Wang1, Yi Yao1 and  Mingyu Wang1*
  • 1Yantai Yuhuangding Hospital, China

Background: The mainstream medications for rheumatoid arthritis (RA) include conventional disease-modifying antirheumatic drugs (cDMARDs), which mostly are methotrexate (MTX), and biologic agents such as adalimumab (ADA), certolizumab (CZP), etanercept (ETN), golimumab (GOL), infliximab (IFX) and tocilizumab (TCZ). This network meta-analysis was aimed at evaluating the efficacy and safety of the medications above and interventions combining cDMARDs and biologic agents for patients with RA.
Methods: PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched systematically for eligible randomized controlled trials (RCTs). Outcomes concerning efficacy and safety were evaluated utilizing odds ratios (ORs) and 95% credible intervals (CrI). The outcomes of efficacy would be evaluated through remission and American College of Rheumatology (ACR) scores. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment on each index.
Results: A total of 20 RCTs with 9047 patients were included, and the efficacy and safety of the concerning interventions for RA were evaluated. Compared with cDMARDs alone, TCZ+MTX, ETN+MTX, IFX+MTX, TCZ and ADA+MTX showed significant statistical advantage on ACR20, ACR50 and ACR70. Apart from that, as for remission, TCZ+MTX, IFX+MTX, TCZ and CZP+MTX performed better compared to cDMARDs alone. The SUCRA ranking also indicated that TCZ+MTX was the intervention with best ranking in the entire four efficacy indexes followed by ETX+MTX and IFX+MTX. However, there was no obvious difference among these medications compared with cDMARDs when it comes to safety, which need more specific studies on that.
Conclusion: TCZ + MTX was potentially the most recommended combination of medications for RA due to its good performance in all outcomes of efficacy. ETX+MTX and IFX+MTX, which also performed well, could be introduced as alternative treatments. However, considering the adverse events, the treatments concerning should be introduced with caution.

Keywords: Rheumatoid arthritis, DMARDs, Safety, efficacy, Network meta-analysis

Received: 25 Nov 2017; Accepted: 08 Feb 2018.

Edited by:

Gerfried K. Nell, NPC Nell Pharma Connect Ltd, Austria

Reviewed by:

Domenico Criscuolo, Genovax S.r.l., Italy
Fathi M. Sherif, University of Tripoli, Libya  

Copyright: © 2018 Cai, Gu, Cui, Cao, Wang, Yao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Mingyu Wang, Yantai Yuhuangding Hospital, Yantai, China, zhangzhiyu72@163.com