A systematic review of the effectiveness of adalimumab

66
Effectiveness
Review: Infliximab for rheumatoid arthritis 2006
Comparison: 03 Infliximab i.v. licensed dose only (3 mg kg –1 every 8 weeks) + MTX vs Placebo + MTX, end of trial
Outcome: 03 ACR70 responder
Study
or subcategory
Infliximab
n/N
Placebo
n/N
01 With concurrent, ongoing MTX
START, 111 [22 weeks] (+)
ATTRACT, 132,133 [54 weeks] (+)
Subtotal (95% CI)
Total events: 57 (infliximab), 18 (placebo)
Test for heterogeneity: 2 = 0.07, df = 1 (p = 0.79), I2 48/343 16/341
9/86 2/88
429 429
= 0%
Test for overall effect: z = 4.77 (p < 0.00001)
02 With concurrent, newly initiated MTX (infliximab + MTX vs MTX)
Quinn, 2005, 141 [54 weeks] (+)
ASPIRE, 135 [54 weeks] (+)
Subtotal (95% CI)
Total events: 121 (infliximab), 61 (placebo)
Test for heterogeneity: 2 = 1.90, df = 1 (p = 0.17), I2 7/10 3/10
114/351 58/274
361 284
= 47.5%
Test for overall effect: z = 3.53 (p = 0.0004)
Total (95% CI)
Total events: 178 (infliximab), 79 (placebo)
Test for heterogeneity: 2 = 2.77, df = 3 (p = 0.43), I2 790 713
= 0%
Test for overall effect: z = 5.68 (p < 0.00001)
FIGURE 40 ACR70 RD: infliximab licensed dose versus placebo (with concurrent MTX)
RD (fixed)
95% CI
–1 –0.5 0 0.5 1
Favours placebo Favours infliximab
Review: Infliximab for rheumatoid arthritis 2006
Comparison: 03 Infliximab i.v. licensed dose only (3 mg kg –1 every 8 weeks) + MTX vs Placebo + MTX, end of trial
Outcome: 12 HAQ, mean change from baseline
Study
or subcategory
01 With concurrent, ongoing MTX
START, 111 [22 weeks] (+)
ATTRACT, 132,133 [54 weeks] (+)
Subtotal (95% CI)
N
Inflaximab
mean (SD) N
Test for heterogeneity: 2 = 0.46, df = 1 (p = 0.50), I 2 = 0%
Test for overall effect: z = 6.74 (p < 0.00001)
02 With concurrent, newly initiated MTX (infliximab + MTX vs MTX)
Quinn, 2005, 141 [54 weeks] (+)
ASPIRE, 135 [54 weeks] (+)
Subtotal (95% CI)
Placebo
mean (SD)
337 –0.39 (0.60) 336 –0.11 (0.51)
77 –0.50 (0.66 68 –0.30 (0.66)
414 404
10 –1.09 (0.65) 10 –0.22 (0.72)
311 –0.83 (0.71) 232 –0.72 (0.72)
321 242
Test for heterogeneity: 2 = 5.90, df = 1 (p = 0.02), I 2 = 83.0%
Test for overall effect: z = 2.30 (p = 0.02)
Total (95% CI)
Test for heterogeneity: 2 = 9.52, df = 3 (p = 0.02), I2 735 646
= 68.5%
Test for overall effect: z = 6.89 (p < 0.00001)
WMD (fixed)
95% CI
–1 –0.5 0 0.5 1
Favours infliximab Favours placebo
FIGURE 41 HAQ change: infliximab licensed dose only versus placebo (with concurrent MTX)
Weight
%
45.80
11.65
57.45
1.34
41.21
42.55
100.00
Weight
%
60.60
9.26
69.85
1.19
28.96
30.15
100.00
RD (fixed)
95% CI
0.09 (0.05 to 0.14)
0.08 (0.01 to 0.15)
0.09 (0.05 to 0.13)
0.40 (0.00 to 0.80)
0.11 (0.04 to 0.18)
0.12 (0.05 to 0.19)
0.10 (0.07 to 0.14)
WMD (fixed)
95% CI
–0.20 (–0.36 to –0.20)
–0.20 (–0.42 to 0.02)
–0.27 (–0.35 to –0.19)
–0.87 (–1.47 to –0.27)
–0.11 (–0.23 to 0.01)
–0.14 (–0.26 to –0.02)
–0.23 (–0.30 to –0.16)