A systematic review of the effectiveness of adalimumab

48
Effectiveness
Review: Etanercept for rheumatoid arthritis 2006
Comparison: 01 Etanercept s.c. licensed dose only (25 mg twice weekly or 50 mg once weekly) vs placebo, end of trial
Outcome: 01 ACR20 responder
Study
or subcategory
Etanercept
n/N
Control
n/N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
Moreland, 1997121 [12 weeks] (–)
Wadjula, 2000126 [12 weeks] (–)
Moreland, 1999122 [26 weeks] (–)
Keystone, 2004129 [8 weeks] (±)
Lan, 2004130 [12 weeks] (+)
Weinblatt, 1999125 [24 weeks] (+)
Codreanu, 2003103 [24 weeks] (+)
Subtotal (95% CI)
Total events: 479 (etanercept), 69 (control)
Test for heterogeneity: 2 = 10.78, df = 6 (p = 0.10), I2 33/44
76/109
46/78
182/367
26/29
42/59
74/100
6/44
12/100
9/80
10/53
10/29
8/30
14/50
786 386
= 44.3%
Test for overall effect: z = 11.55 (p < 0.00001)
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO 110 [100 weeks] (+)
Subtotal (95% CI)
Total events: 152 (etanercept), 101 (control)
Test for heterogeneity: NA
Test for overall effect: z = 4.49 (p < 0.00001)
152/231 101/228
231 228
Total (95% CI)
Total events: 631 (etanercept), 170 (control)
Test for heterogeneity: 2 = 57.50, df = 7 (p < 0.00001), I2 1017 614
= 86.4%
Test for overall effect: z = 12.47 (p < 0.00001)
RR (fixed)
95% CI
0.01 0.1 1 10 100
Favours control Favours etanercept
Weight
%
3.23
6.74
4.78
9.41
5.38
5.71
10.05
45.29
54.71
54.71
100.00
FIGURE 24 ACR20 RR: etanercept licensed dose versus placebo (including etanercept plus MTX versus MTX)
Review: Etanercept for rheumatoid arthritis 2006
Comparison: 01 Etanercept s.c. licensed dose only (25 mg twice weekly or 50 mg once weekly) vs placebo, end of trial
Outcome: 01 ACR20 responder
Study
or subcategory
Etanercept
n/N
Control
n/N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
Moreland, 1997121 [12 weeks] (–)
Wadjula, 2000126 [12 weeks] (–)
Moreland, 1999122 [26 weeks] (–)
Keystone, 2004129 [8 weeks] (±)
Lan, 2004130 [12 weeks] (+)
Weinblatt, 1999125 [24 weeks] (+)
Codreanu, 2003103 [24 weeks] (+)
Subtotal (95% CI)
Total events: 479 (etanercept), 69 (control)
Test for heterogeneity: 2 = 14.77, df = 6 (p = 0.02), I2 33/44
76/109
46/78
182/367
26/29
42/59
74/100
6/44
12/100
9/80
10/53
10/29
8/30
14/50
786 386
= 59.4%
Test for overall effect: z = 17.47 (p < 0.00001)
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO 110 [100 weeks] (+)
Subtotal (95% CI)
Total events: 152 (etanercept), 101 (control)
Test for heterogeneity: NA
Test for overall effect: z = 4.74 (p < 0.00001)
152/231 101/228
231 228
Total (95% CI)
Total events: 631 (etanercept), 170 (control)
Test for heterogeneity: 2 = 40.99, df = 7 (p < 0.00001), I2 1017 614
= 82.9%
Test for overall effect: z = 16.45 (p < 0.00001)
RD (fixed)
95% CI
–1 –0.5 0 0.5 1
Favours control Favours etanercept
Weight
%
6.42
15.23
11.53
13.52
4.23
5.81
9.73
66.49
33.51
100.00
FIGURE 25 ACR20 RD: etanercept licensed dose versus placebo (including etanercept plus MTX versus MTX)
RR (fixed)
95% CI
5.50 (2.56 to 11.79)
5.81 (3.37 to 10.02)
5.24 (2.76 to 9.97)
2.63 (1.49 to 4.64)
2.60 (1.55 to 4.36)
2.67 (1.44 to 4.94)
2.64 (1.67 to 4.18)
3.59 (2.89 to 4.46)
1.49 (1.25 to 1.77)
1.49 (1.25 to 1.77)
RD (fixed)
95% CI
0.61 (0.45 to 0.78)
0.58 (0.47 to 0.68)
0.48 (0.35 to 0.61)
0.31 (0.19 to 0.42)
0.55 (0.35 to 0.76)
0.45 (0.25 to 0.64)
0.46 (0.31 to 0.61)
0.48 (0.42 to 0.53)
0.22 (0.13 to 0.30)
0.22 (0.13 to 0.30)