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Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis: a systematic review and meta-analysis

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Abstract

Patients with ankylosing (AS) often do not have a satisfactory response to, or could not tolerate, non-steroidal anti-inflammatory drugs (NSAIDs). Several biologic agents are available for such patients. However, the comparative efficacy of these treatments remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of biologic agents in patients with AS who had inadequate response to, or could not tolerate, NSAIDs were identified. If at least two RCTs were available for a given biologic agent, the pooled odds ratio (OR) and 95% confidence interval (CI) of achieving 20% improvement according to the Ankylosing Spondylitis Assessment Study group response criteria 20 (ASAS20) across trials were calculated. The pooled OR for each biologic agent was then compared to each other using the indirect comparison technique. A total of 14 RCTs of older TNF inhibitors, two RCTs of secukinumab, one RCT of certolizumab, and one RCT of tofacitinib were identified. No significant difference in any indirect comparisons was observed with the p values ranging from 0.12 to 0.74. The likelihood of achieving the ASAS20 response in patients AS who failed or could not tolerate NSAIDs was not significantly different between older TNF inhibitors, secukinumab, certolizumab, and tofacitinib. However, the analysis is limited by the small sample size with only one RCT for certolizumab and tofacitinib.

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Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA

    Patompong Ungprasert & Matthew J. Koster

  2. Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand

    Patompong Ungprasert

  3. Mayo Clinic Libraries, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA

    Patricia J. Erwin

Authors
  1. Patompong Ungprasert
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  2. Patricia J. Erwin
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  3. Matthew J. Koster
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Contributions

Patompong Ungprasert: Study design, literature search, statistical analysis, and writing manuscript.

Patricia J. Erwin: Literature search and approval of manuscript.

Matthew J. Koster: Study design, literature search, and approval of manuscript.

Corresponding author

Correspondence to Patompong Ungprasert.

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Funding

This study was supported by a grant (CTSA Grant Number UL1 TR000135) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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None.

Electronic supplementary material

ESM 1

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Supplementary figure 1:

Funnel plot of older TNF inhibitors (BMP 1240 kb)

Supplementary figure 2:

Risk of bias for individual study (green, low; yellow, unclear; red, high) (BMP 1562 kb)

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Ungprasert, P., Erwin, P.J. & Koster, M.J. Indirect comparisons of the efficacy of biological agents in patients with active ankylosing spondylitis: a systematic review and meta-analysis. Clin Rheumatol 36, 1569–1577 (2017). https://doi.org/10.1007/s10067-017-3693-7

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  • DOI: https://doi.org/10.1007/s10067-017-3693-7

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