A systematic review of the effectiveness of adalimumab

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: 02 ACR50 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: 253 (etanercept), 26 (control)
Test for heterogeneity: 2 = 4.01, df = 6 (p = 0.68), I2 25/44
37/109
31/78
66/367
19/29
23/59
52/100
3/44
5/100
4/80
3/53
3/29
1/30
7/50
786 386
= 0%
Test for overall effect: z = 9.05 (p < 0.00001)
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO 110 [100 weeks] (+)
Subtotal (95% CI)
Total events: 132 (etanercept), 68 (control)
Test for heterogeneity: NA
Test for overall effect: z = 5.58 (p < 0.00001)
132/231 68/228
231 228
Total (95% CI)
Total events: 385 (etanercept), 94 (control)
Test for heterogeneity: 2 = 30.13, df = 7 (p < 0.0001), I2 1017 614
= 76.8%
Test for overall effect: z = 10.99 (p < 0.00001)
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Health Technology Assessment 2006; Vol. 10: No. 42
RR (fixed)
95% CI
0.01 0.1 1 10 100
Favours control Favours etanercept
Weight
%
3.01
5.24
3.97
5.27
3.01
1.33
9.38
31.22
68.78
68.78
100.00
FIGURE 26 ACR50 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: 02 ACR50 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: 253 (etanercept), 26 (control)
Test for heterogeneity: 2 = 38.84, df = 6 (p < 0.00001), I2 25/44
37/109
31/78
66/367
19/29
23/59
52/100
3/44
5/100
4/80
3/53
3/29
1/30
7/50
786 386
= 84.6%
Test for overall effect: z = 13.65 (p < 0.00001)
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO 110 [100 weeks] (+)
Subtotal (95% CI)
Total events: 132 (etanercept), 68 (control)
Test for heterogeneity: NA
Test for overall effect: z = 6.14 (p < 0.00001)
132/231 68/228
231 228
Total (95% CI)
Total events: 385 (etanercept), 94 (control)
Test for heterogeneity: 2 = 37.23, df = 7 (p < 0.00001), I2 1017 614
= 81.2%
Test for overall effect: z = 14.13 (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
33.51
100.00
FIGURE 27 ACR50 RD: etanercept licensed dose versus placebo (including etanercept plus MTX versus MTX)
RR (fixed)
95% CI
8.33 (2.71 to 25.60)
6.79 (2.78 to 16.59)
7.95 (2.94 to 21.47)
3.18 (1.04 to 9.74)
6.33 (2.10 to 19.09)
11.69 (1.66 to 82.47)
3.71 (1.82 to 7.57)
5.72 (3.92 to 8.34)
1.92 (1.52 to 2.41)
1.92 (1.52 to 2.41)
RD (fixed)
95% CI
0.50 (0.34 to 0.66)
0.29 (0.19 to 0.39)
0.35 (0.23 to 0.47)
0.12 (0.05 to 0.20)
0.55 (0.35 to 0.76)
0.36 (0.22 to 0.50)
0.38 (0.24 to 0.52)
0.32 (0.28 to 0.37)
0.27 (0.19 to 0.36)
0.27 (0.19 to 0.36)
49