A Bayesian mixed treatment comparison of efficacy of biologics and small molecules in early rheumatoid arthritis

  • Vincenzo Venerito
  • Giuseppe Lopalco
  • Fabio Cacciapaglia
  • Marco Fornaro
  • Florenzo Iannone
Review Article
Part of the following topical collections:
  1. Autoimmune Collection 2018


The current paradigm in the management of rheumatoid arthritis (RA) is to treat patients in the early stage of the disease (ERA). Previous meta-analysis-based mixed treatment comparisons (MTCs), aimed to identify the most effective drugs in ERA, are biased by the wide “window” of early definition, ranging from 6 months to 2 years. The aim of this study was to estimate through a Bayesian Network Meta-Analysis which biologics or small molecules are more likely to achieve a 1-year good clinical response in ERA patients with disease duration < 1 year. According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, randomized controlled trials (RCTs) of biologic agents and small molecules in combination with MTX to treat patients affected with ERA lasting < 1 year were searched through MEDLINE, EMBASE, Cochrane Library, and between 1990 and September 2017. The outcome of interest was the achievement of American College of Rheumatology (ACR) 50 and ACR 70 response at 1 year. WinBUGS 1.4 software (MRC Biostatistics Unit, Cambridge, UK) was used to perform the analyses, using a fixed effect model. Fourteen studies were included in the analysis. Tofacitinib (64.83%) followed by Etanercept (23.26%) were the drugs with the highest probability of achieving ACR50 response. Rituximab showed the highest probability of inducing ACR70 response (52.81%) followed by Etanercept (26.85%). This is the first MTC involving only RCTs on ERA patients with disease duration < 1 year. Tofacitinib and rituximab were the drugs ranked first in inducing 1-year ACR50 and ACR70 response, respectively.


Early Efficacy Meta-analysis Rheumatoid arthritis Rituximab Tofacitinib 


Compliance with ethical standards



Supplementary material

10067_2018_4406_MOESM1_ESM.pdf (69 kb)
ESM 1 (PDF 68 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Rheumatology Unit, Department of Emergency and Organ TransplantationsPoliclinicoBariItaly

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