A systematic review of the effectiveness of adalimumab

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Effectiveness
Review: Adalimumab for rheumatoid arthritis 2006
Comparison: 03 Adalimumab s.c. licensed dose only (40 mg every other week or equivalent) vs placebo, end of trial
Outcome: 02 ACR50 responder
Study
or subcategory
Adalimumab
n/N
Control
n/N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
van de Putte, 2003119 [12 weeks] (–)
van de Putte, 2004113 [26 weeks] (–)
STAR115 [24 weeks] (±)
ARMADA112 [24 weeks] (+)
Keystone, 2004114 [52 weeks] (+)
Subtotal (95% CI)
Total events: 360 (adalimumab), 69 (control)
Test for heterogeneity: 2 = 8.66, df = 4 (p = 0.07), I2 17/71 1/70
48/225 9/110
92/315 35/315
37/67 5/62
166/419 19/200
1097 757
= 53.8%
Test for overall effect: z = 10.25 (p < 0.00001)
02 With concurrent, newly initiated MTX (adalimumab + MTX vs MTX)
PREMIER 102,109 [104 weeks] (+)
Subtotal (95% CI)
Total events: 158 (adalimumab), 110 (control)
Test for heterogeneity: NA
Test for overall effect: z = 3.63 (p = 0.0003)
158/268 110/257
268 257
Subtotal (95% CI)
Total events: 518 (adalimumab), 179 (control)
Test for heterogeneity: 2 = 50.80, df = 5 (p < 0.00001), I2 1365 1014
= 90.2%
Test for overall effect: z = 10.91 (p < 0.00001)
RR (fixed)
(95% CI)
0.1 0.2 0.5 1 2 5 10
Favours control Favours adalimumab
Weight
(%)
0.53
6.32
18.29
2.71
13.44
41.30
58.70
58.70
100.00
FIGURE 4 ACR50 RR: adalimumab licensed dose versus placebo (including adalimumab plus MTX versus MTX)
Review: Adalimumab for rheumatoid arthritis 2006
Comparison: 03 Adalimumab s.c. licensed dose only (40 mg every other week or equivalent) vs placebo, end of trial
Outcome: 02 ACR50 responder
Study
or subcategory
Adalimumab
n/N
Control
n/N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
van de Putte, 2003119 [12 weeks] (–)
van de Putte, 2004113 [26 weeks] (–)
STAR115 [24 weeks] (±)
ARMADA112 [24 weeks] (+)
Keystone, 2004114 [52 weeks] (+)
Subtotal (95% CI)
Total events: 360 (adalimumab), 69 (control)
Test for heterogeneity: 2 = 26.38, df = 4 (p < 0.0001), I2 17/71 1/70
48/225 9/110
92/315 35/315
37/67 5/62
166/419 19/200
1097 757
= 84.8%
Test for overall effect: z = 13.33 (p < 0.00001)
02 With concurrent, newly initiated MTX (adalimumab + MTX vs MTX)
PREMIER 102,109 [104 weeks] (+)
Subtotal (95% CI)
Total events: 158 (adalimumab), 110 (control)
Test for heterogeneity: NA
Test for overall effect: z = 3.75 (p = 0.0002)
158/268 110/257
268 257
Subtotal (95% CI)
Total events: 518 (adalimumab), 179 (control)
Test for heterogeneity: 2 = 28.46, df = 5 (p < 0.0001), I2 1365 1014
= 82.4%
Test for overall effect: z = 12.95 (p < 0.00001)
RD (fixed)
(95% CI)
–1 –0.5 1 0.5 1
Favours control Favours adalimumab
Weight
(%)
6.23
13.07
27.86
5.70
23.94
76.80
23.20
23.20
100.00
FIGURE 5 ACR50 RD: adalimumab licensed dose versus placebo (including adalimumab plus MTX versus MTX)
RR (fixed)
(95% CI)
16.76 (2.29 to 122.56)
2.61 (1.33 to 5.12)
2.63 (1.84 to 3.75)
6.85 (2.88 to 16.31)
4.17 (2.68 to 6.50)
3.58 (2.81 to 4.58)
1.38 (1.16 to 1.64)
1.38 (1.16 to 1.64)
RD (fixed)
(95% CI)
0.23 (0.12 to 0.33)
0.13 (0.06 to 0.21)
0.18 (0.12 to 0.24)
0.47 (0.33 to 0.61)
0.30 (0.24 to 0.36)
0.24 (0.20 to 0.27)
0.16 (0.08 to 0.25)
0.16 (0.08 to 0.25)