A systematic review of the effectiveness of adalimumab

Review: Infliximab for rheumatoid arthritis 2006
Comparison: 03 Infliximab i.v. licensed dose only (3 mg kg –1 every 8 weeks) + MTX vs Placebo + MTX, end of trial
Outcome: 02 ACR50 responder
Study
or subcategory
Infliximab
n/N
Placebo
n/N
01 With concurrent, ongoing MTX
START, 111 [22 weeks] (+)
ATTRACT, 132,133 [54 weeks] (+)
Subtotal (95% CI)
Total events: 128 (infliximab), 40 (placebo)
Test for heterogeneity: 2 = 2.45, df = 1 (p = 0.12), I2 110/343 33/341
18/86 7/88
429 429
= 59.2%
Test for overall effect: z = 7.86 (p < 0.00001)
02 With concurrent, newly initiated MTX (infliximab + MTX vs MTX)
Quinn, 2005, 141 [54 weeks] (+)
ASPIRE, 135 [54 weeks] (+)
Subtotal (95% CI)
Total events: 168 (infliximab), 92 (placebo)
Test for heterogeneity: 2 = 1.70, df = 1 (p = 0.19), I2 8/10 4/10
160/351 88/274
361 284
= 41.1%
Test for overall effect: z = 3.76 (p = 0.0002)
Total (95% CI)
Total events: 296 (infliximab), 132 (placebo)
Test for heterogeneity: 2 = 2.68, df = 3 (p = 0.13), I2 790 713
= 47.2%
Test for overall effect: z = 8.09 (p < 0.0001)
FIGURE 38 ACR50 RD: infliximab licensed dose versus placebo (with concurrent MTX)
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Health Technology Assessment 2006; Vol. 10: No. 42
RD (fixed)
95% CI
–1 –0.5 0 0.5 1
Favours placebo Favours infliximab
Review: Infliximab for rheumatoid arthritis 2006
Comparison: 03 Infliximab i.v. licensed dose only (3 mg kg –1 every 8 weeks) + MTX vs Placebo + MTX, end of trial
Outcome: 03 ACR70 responder
Study
or subcategory
Infliximab
n/N
Placebo
n/N
01 With concurrent, ongoing MTX
START, 111 [22 weeks] (+)
ATTRACT, 132,133 [54 weeks] (+)
Subtotal (95% CI)
Total events: 57 (infliximab), 18 (placebo)
Test for heterogeneity: 2 = 0.28, df = 1 (p = 0.59), I2 48/343 16/341
9/86 2/88
429 429
= 0%
Test for overall effect: z = 4.40 (p < 0.0001)
02 With concurrent, newly initiated MTX (infliximab + MTX vs MTX)
Quinn, 2005, 141 [54 weeks] (+)
ASPIRE, 135 [54 weeks] (+)
Subtotal (95% CI)
Total events: 121 (infliximab), 61 (placebo)
Test for heterogeneity: 2 = 0.60, df = 1 (p = 0.44), I2 7/10 3/10
114/351 58/274
361 284
= 0%
Test for overall effect: z = 3.34 (p = 0.0008)
Total (95% CI)
Total events: 178 (infliximab), 79 (placebo)
Test for heterogeneity: 2 = 6.46, df = 3 (p = 0.09), I2 790 713
= 53.5%
Test for overall effect: z = 5.36 (p < 0.00001)
FIGURE 39 ACR70 RR: infliximab licensed dose versus placebo (with concurrent MTX)
RR (fixed)
95% CI
0.1 0.2 0.5 1 2 5 10
Favours placebo Favours infliximab
Weight
%
45.80
11.65
57.45
1.34
41.21
42.55
100.00
Weight
%
18.62
2.29
20.92
3.48
75.60
79.08
100.00
RD (fixed)
95% CI
0.22 (0.17 to 0.28)
0.13 (0.03 to 0.23)
0.20 (0.15 to 0.26)
0.40 (0.01 to 0.79)
0.13 (0.06 to 0.21)
0.14 (0.07 to 0.22)
0.18 (0.14 to 0.22)
RR (fixed)
95% CI
2.98 (1.73 to 5.15)
4.60 (1.02 to 20.70)
3.16 (1.89 to 5.27)
2.33 (0.83 to 6.54)
1.53 (1.17 to 2.02)
1.57 (1.20 to 2.05)
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