Few clear differences between TNF inhibitors for the treatment of ankylosing spondylitis
medwireNews: Results of a systematic review and network meta-analysis suggest that all tumor necrosis factor (TNF) inhibitors are superior to placebo for the treatment of ankylosing spondylitis (AS), with no substantial differences in efficacy seen between the different agents.
The analysis included 20 randomized controlled trials of six TNF inhibitors – adalimumab; certolizumab pegol; etanercept; golimumab; infliximab; and the infliximab biosimilar CT-P13 – involving 3220 AS patients with a mean age of 27.4 to 48.0 years. The majority (90%) of trials were placebo-controlled, whereas one trial compared open-label infliximab with etanercept, and another compared CT-P13 with infliximab.
As reported in The Journal of Rheumatology, patients receiving any TNF inhibitor experienced a significantly greater reduction in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score from baseline to week 12 compared with those receiving placebo, with mean relative reductions ranging from 1.45 to 2.66 points.
Similarly, all TNF inhibitors were associated with a significantly greater reduction in Bath Ankylosing Spondylitis Functional Index (BASFI) scores at 12 weeks compared with placebo (mean difference=1.05–1.99 points), and all except certolizumab pegol were significantly better than placebo in reducing levels of C-reactive protein.
When the different drugs were indirectly compared with each other in a Bayesian network meta-analysis, infliximab was associated with a significantly greater reduction in BASDAI scores at 12 weeks compared with the other TNF inhibitors. However, when the open-label comparison of infliximab versus etanercept was excluded from the analysis, this difference was no longer statistically significant.
Runsheng Wang, from Columbia University Medical Center in New York, USA, and co-authors acknowledge that “the advantage of [infliximab] at 12 weeks in BASDAI responses should be interpreted cautiously,” noting that their study was limited by “the small number of head-to-head trials” that are currently available.
Nevertheless, they believe that “these results may assist in the choice of TNF [inhibitor] in clinical situations when prompt symptom responses are needed,” although such situations are “uncommon” in AS patients.
And the team concludes that “more information on the relative safety and long-term effectiveness of TNF [inhibitors] will provide critical guidance on the choice of TNF [inhibitor] in the treatment of AS in clinical practice.”
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