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: 12 HAQ, end of study result
Study
or subcategory
N
Etanercept
mean (SD) N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
Wadjula, 2000 126 [12 weeks] (–)
Moreland, 1999 122 [26 weeks] (–)
Keystone, 2004 129 [8 weeks] (±)
Lan, 2004 130 [12 weeks] (+)
Weinblatt, 1999 125 [24 weeks] (+)
Codreanu, 2003 103 [24 weeks] (+)
Subtotal (95% CI)
Test for heterogeneity: 2 = 6.28, df = 5 (p = 0.28), I 2 = 20.4%
Test for overall effect: z = 11.36 (p < 0.00001)
Control
mean (SD)
99 1.30 (0.60) 81 1.70 (0.60)
78 1.00 (0.80) 80 1.70 (0.70)
367 1.00 (0.60) 53 1.50 (0.60)
29 0.34 (0.60) 29 0.99 (0.60)
59 0.90 (0.70) 30 1.20 (0.80)
100 1.00 (0.60) 50 1.50 (0.50)
732 323
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO110 [100 weeks] (+) 231 0.70 (0.60) 228 1.10 (0.70)
Subtotal (95% CI)
Test for heterogeneity: NA
231 228
Test for overall effect: z = 6.57 (p < 0.00001)
Total (95% CI)
Test for heterogeneity: 2 = 8.11, df = 6 (p = 0.23), I2 963 551
= 26.0%
Test for overall effect: z = 13.05 (p < 0.00001)
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Health Technology Assessment 2006; Vol. 10: No. 42
WMD (fixed)
95% CI
–1 –0.5 0 0.5 1
Favours etanercept Favours control
Weight
%
FIGURE 30 HAQ change: etanercept licensed dose only 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: 07 SAEs
Study
or subcategory
Etanercept
n/N
Control
n/N
01 With (+) or without (–) concurrent, ongoing conventional DMARDs
Moreland, 1999122 [26 weeks] (–)
Keystone, 2004129 [8 weeks] (±)
Baumgartner, 2004104 [20 weeks] (±)
Weinblatt, 1999125 [24 weeks] (+)
Codreanu, 2003103 [24 weeks] (+)
Subtotal (95% CI)
Total events: 37 (etanercept), 23 (control)
Test for heterogeneity: 2 = 3.28, df = 4 (p = 0.51), I2 2/78
5/367
23/266
2/59
5/101
3/80
0/53
16/269
3/30
1/50
871 482
= 0%
Test for overall effect: z = 0.84 (p = 0.40)
02 With concurrent, newly initiated MTX (etanercept + MTX)
TEMPO 110 [104 weeks] (+)
Subtotal (95% CI)
Total events: 52 (etanercept), 41 (control)
Test for heterogeneity: NA
Test for overall effect: z = 1.20 (p = 0.23)
52/231 41/228
231 228
Total (95% CI)
Total events: 89 (etanercept), 64 (control)
Test for heterogeneity: 2 = 3.29, df = 5 (p = 0.66), I2 1102 710
= 0%
Test for overall effect: z = 1.46 (p = 0.14)
RR (fixed)
95% CI
0.01 0.1 1 10 100
Favours etanercept Favours control
15.82
8.92
16.45
5.15
4.31
14.87
65.52
34.48
34.48
100.00
Weight
%
4.47
1.31
23.99
6.00
2.02
37.78
62.22
62.22
100.00
FIGURE 31 SAE RR: etanercept licensed dose only versus placebo (including etanercept plus MTX versus MTX)
WMD (fixed)
95% CI
–0.40 (–0.58 to –0.22)
–0.70 (–0.93 to –0.47)
–0.50 (–0.67 to –0.33)
–0.65 (–0.96 to –0.34)
–0.30 (–0.64 to 0.04)
–0.50 (–0.68 to –0.32)
–0.50 (–0.59 to –0.42)
–0.40 (–0.52 to –0.28)
–0.40 (–0.52 to –0.28)
–0.47 (–0.54 to –0.40)
RR (fixed)
95% CI
0.68 (0.12 to 3.98)
1.61 (0.09 to 28.78)
1.45 (0.79 to 2.69)
0.34 (0.06 to 1.92)
2.48 (0.30 to 20.62)
1.25 (0.75 to 2.08)
1.25 (0.87 to 1.81)
1.25 (0.87 to 1.81)
1.25 (0.93 to 1.68)
51