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2016 ; 95
(11
): e3060
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Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing
Spondylitis: A Systematic Review and a Network Meta-Analysis
#MMPMID26986130
Chen C
; Zhang X
; Xiao L
; Zhang X
; Ma X
Medicine (Baltimore)
2016[Mar]; 95
(11
): e3060
PMID26986130
show ga
To establish the comparative effectiveness of all available biologic therapy
regimens for ankylosing spondylitis, we performed a systematic review and a
Bayesian network meta-analysis of randomized controlled trials. PubMed, Medline,
Embase, Cochrane library, and ClinicalTrials.gov were searched from the inception
of each database to June 2015. Systematic review and network meta-analysis was
reported according to the Preferred Reporting Items of Systematic Reviews and
Meta-Analyses Extension Statement for Reporting of Systematic Reviews
Incorporating Network Meta-analyses. The primary outcome was 20% improvement of
Assessments in SpondyloArthritis International Society Response Criteria (ASAS20)
at Week 12 or 14; secondary outcomes were ASAS40, ASAS5/6, ASAS partial remission
and 50% improvement in baseline Bath ankylosing spondylitis (AS) disease activity
index. We reported relative risks and 95% confidence intervals from direct
meta-analysis and 95% credible intervals from Bayesian network meta-analysis, and
ranked the treatment for outcomes. We also used Grading of Recommendations
Assessment, Development and Evaluation criteria to appraise quality of evidence.
Fourteen RCTs comprising 2672 active AS patients were included in the network
meta-analysis. Most biologic therapy regimens were more effective than placebo
regarding all the outcomes assessed, except for secukinumab and tocilizumab. No
differences between biologic therapies in the treatment of AS could be found,
except for the finding that infliximab 5 mg was superior to tocilizumab.
Infliximab 5 mg/kg had the highest probability of being ranked the best for
achieving ASAS20, whereas notably, secukinumab had the highest probability of
being ranked the second best. Our study suggests that no differences between
biologic therapies in the treatment of AS could be found except that infliximab 5
mg was superior to tocilizumab. Infliximab 5 mg/kg seems to be the better
biologic therapy regimen for AS. Secukinumab appears promising, though additional
data is warranted. Nevertheless, these interpretations should be accepted very
cautiously.