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Gartlehner G, Thieda P, Morgan LC, et al. Drug Class Review: Targeted Immune Modulators: Final Report Update 2 [Internet]. Portland (OR): Oregon Health & Science University; 2009 Nov.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Drug Class Review: Targeted Immune Modulators

Drug Class Review: Targeted Immune Modulators: Final Report Update 2 [Internet].

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Conclusions

Overall, targeted immune modulators are highly effective medications for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn’s disease, ulcerative colitis, and plaque psoriasis that substantially improve the burden of disease and are generally safe for short-term treatment. The evidence is currently insufficient to reliably determine the comparative effectiveness and safety for most comparisons. In addition, for many drugs the balance between benefits and risks cannot be reliably assessed without sound long-term data on safety.

Table 33Summary of the evidence by key question

Key questionStrength of evidenceConclusion
1. Comparative efficacy for rheumatoid arthritisModerate

Low

Insufficient

Moderate

Low

Insufficient
Based on 1 randomized controlled trial, no difference in efficacy between abatacept and infliximab

Based on indirect comparisons and 1 observational study, no difference in effectiveness between adalimumab and etanercept

Based on indirect comparisons and 1 observational study, conflicting evidence on the comparative effectiveness of adalimumab and infliximab

Based on 2 trials and 4 observational studies, greater effectiveness of etanercept than infliximab

Based on indirect comparisons, greater effectiveness of adalimumab, etanercept, and infliximab compared with anakinra

No evidence available for all other comparisons
1. Comparative effectiveness for juvenile idiopathic arthritisInsufficientNo comparative evidence available
1. Comparative effectiveness for ankylosing spondylitisLowBased on indirect comparisons, no difference in effectiveness between adalimumab, etanercept and/or infliximab
1. Comparative effectiveness for psoriatic arthritisLowBased on indirect comparisons, no difference in effectiveness between adalimumab, etanercept and/or infliximab
1. Comparative effectiveness for Crohn’s diseaseInsufficientNo comparative evidence available
1. Comparative effectiveness for ulcerative colitisInsufficientNo comparative evidence available
1. Comparative effectiveness for plaque psoriasisInsufficientNo comparative evidence available
2. Comparative safetyModerate

Low

Insufficient

High
Based on 1 randomized controlled trial, higher rates of serious adverse events and serious infections for infliximab than for abatacept

Based on 1 trial and 1 observational study, no differences between etanercept and infliximab

No evidence available for all other comparisons

Based on 2 randomized controlled trials, substantially higher rates of serious adverse events for combination therapies of anakinra with etanercept and abatacept with etanercept than for monotherapies
3. Subgroups - ageInsufficientThe evidence on the effect of age is contradicting and insufficient to draw conclusions
3. Subgroups - sexInsufficientThe evidence is mixed and insufficient to draw conclusions
3. Subgroups - ethnicityInsufficientThe evidence is mixed and insufficient to draw conclusions
3. Subgroups - comorbiditiesInsufficientThe evidence is mixed and insufficient to draw conclusions
Copyright © 2009, Oregon Health & Science University, Portland, Oregon.
Bookshelf ID: NBK47226
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