Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis
Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2–4 RCTs evaluating patients with RA refractor...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Advances in Rheumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42358-023-00298-z |
| _version_ | 1797784337499815936 |
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| author | Alisson Pugliesi Amanda Borges de Oliveira Ana Beatrice Oliveira Ricardo Xavier Licia Maria Henrique da Mota Manoel Barros Bertolo Miguel Angel Gonzalez-Gay Gustavo Citera Luiz Sergio Fernandes de Carvalho |
| author_facet | Alisson Pugliesi Amanda Borges de Oliveira Ana Beatrice Oliveira Ricardo Xavier Licia Maria Henrique da Mota Manoel Barros Bertolo Miguel Angel Gonzalez-Gay Gustavo Citera Luiz Sergio Fernandes de Carvalho |
| author_sort | Alisson Pugliesi |
| collection | DOAJ |
| description | Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2–4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113–10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554–3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab. |
| first_indexed | 2024-03-13T00:38:27Z |
| format | Article |
| id | doaj.art-1d83565b4cf54c51a501773c721f7c97 |
| institution | Directory Open Access Journal |
| issn | 2523-3106 |
| language | English |
| last_indexed | 2024-03-13T00:38:27Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Advances in Rheumatology |
| spelling | doaj.art-1d83565b4cf54c51a501773c721f7c972023-07-09T11:28:29ZengBMCAdvances in Rheumatology2523-31062023-07-0163111010.1186/s42358-023-00298-zCompared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysisAlisson Pugliesi0Amanda Borges de Oliveira1Ana Beatrice Oliveira2Ricardo Xavier3Licia Maria Henrique da Mota4Manoel Barros Bertolo5Miguel Angel Gonzalez-Gay6Gustavo Citera7Luiz Sergio Fernandes de Carvalho8Hospital de Clínicas, Faculty of Medical Sciences, State University of Campinas (UNICAMP)Neurosurgery Unit of the Hospital de Base Do Distrito Federal BaseHealth Sciences Research and Teaching Foundation of Brasília (ESCS/FEPECS)Rheumatology Service, Federal University of Rio Grande Do Sul, Hospital de Clínicas de Porto AlegreHospital Universitário de Brasília, University of Brasília (HUB-UnB-EBSERH)Hospital de Clínicas, Faculty of Medical Sciences, State University of Campinas (UNICAMP)Division of Rheumatology, Hospital Universitário Marqués de Valdecilla, IDIVAL, Universidad de CantabriaSection of Rheumatology, Instituto de Rheabilitacion PsicofisicaHealth Sciences Research and Teaching Foundation of Brasília (ESCS/FEPECS)Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2–4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113–10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554–3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.https://doi.org/10.1186/s42358-023-00298-zRheumatoid arthritisRituximabAbataceptTocilizumabbDMARDAmerican college of rheumatology |
| spellingShingle | Alisson Pugliesi Amanda Borges de Oliveira Ana Beatrice Oliveira Ricardo Xavier Licia Maria Henrique da Mota Manoel Barros Bertolo Miguel Angel Gonzalez-Gay Gustavo Citera Luiz Sergio Fernandes de Carvalho Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis Advances in Rheumatology Rheumatoid arthritis Rituximab Abatacept Tocilizumab bDMARD American college of rheumatology |
| title | Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis |
| title_full | Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis |
| title_fullStr | Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis |
| title_full_unstemmed | Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis |
| title_short | Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis |
| title_sort | compared efficacy of rituximab abatacept and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or tnf inhibitors agents a systematic review and network meta analysis |
| topic | Rheumatoid arthritis Rituximab Abatacept Tocilizumab bDMARD American college of rheumatology |
| url | https://doi.org/10.1186/s42358-023-00298-z |
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