Comparative effectiveness of cycling of tumor necrosis factor-a (TNF-a) inhibitors versus switching to non-TNF biologics in rheumatoid arthritis patients with inadequate response to TNF-a inhibitor using a Bayesian approach

Abstract

Alternative tumor necrosis factor-a (TNF-a)inhibitors and non-TNF biologics are available as treatmentoptions for rheumatoid arthritis patients who exhibit inadequateresponse to TNF-a inhibitor (TNF-IR patients). Theseagents have considerable efficacy compared with placebo,but head-to-head comparisons among these agents have notbeen performed. The objective of this study was to useBayesian approach to compare the effectiveness of cyclingTNF-a inhibitors versus switching to non-TNF biologics inTNF-IR patients. A systematic review was conducted usingMEDLINE and Cochrane library. Key endpoints were theAmerican College of Rheumatology (ACR) responses of20/50/70 and the health assessment questionnaire (HAQ)score change at six months. Bayesian outcomes were calculatedas the probability that OR is greater than one andHAQ score change difference is less than zero. Comparedwith TNF-a inhibitors, non-TNF biologics were associatedwith higher ACR response rates; in ACR20, the OR was1.639 for abatacept [P(OR[1) = 90.7 %], 1.871 for rituximab[P(OR[1) = 96.2 %] and 3.52 for tocilizumab[P(OR[1) = 99.9 %]. Similar trends were shown in theHAQ change comparison; the median differences (MD)were -0.259 for abatacept [P(MD\0) = 100 %], -0.160for rituximab [P(MD\0) = 98.2 %], and -0.200 for tocilizumab[P(MD\0) = 99.3 %]. In conclusion, switchingto non-TNF biologics was more effective than cycling TNFainhibitor in TNF-IR patients.