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Table 13Disease activity and remission for biologic DMARD versus biologic DMARD studies

StudyStudy Design
N
Duration
Study PopulationComparison (dose)ResultsQuality Rating
Abatacept vs. Infliximab
*Schiff, et al., 200866
ATTEST study
RCT
431
1 year
Patients who have failed MTX; active RA; mean disease duration 7.3–8.4 yearsABA (~10 mg/kg every 4 weeks) vs. INF (3 mg/kg every 8 weeks)Greater decrease in DAS28 for ABA vs. INF at 1 year (estimate of difference −0.62 95% CI, −0.96 to −0.29).
Trend toward greater remission for ABA vs. INF at 1 year (estimate of difference 6.5%; 95% CI, −2.2 to 15.2, P=NS, NR)
Fair
*Hetland et al., 201073
DANBIO
Prospective cohort
2,326
6 months(48 months)
Patients with RA initiating therapy with biologic DMARDsADA (mean: 40 mg) wks) vs. ETN (mean 45 mg) vs. INF (mean 3.5 mg/kg)Higher achievement of ACR 70 response after 6 months for ADA than INF (OR 2.05, 95% CI, 1.52 to 2.76, P=NR)Fair
*Kievit et al., 200871Prospective cohort
707
1 year
Population-based, Netherlands, Anti-TNF naïve patients, failed at least 2 DMARDs; mean disease duration 6–7.7 yearsADA vs. INF (dosages NR)Greater decrease in DAS28 for ADA vs. INF at 1 year (ADA −1.8, INF −1.2; P<0.05)Fair
Adalimumab vs. Etanercept
*Hetland et al., 201073
DANBIO
Prospective cohort
2,326
6 monhs (48 months)
Patients with RA initiating therapy with biologic DMARDsADA (mean: 40 mg) wks) vs. ETN (mean 45 mg) vs. INF (mean 3.5 mg/kg)No difference in achievement of ACR 70 response after 6 months for ADA vs. ETN (OR 1.15, 95% CI, 0.82 to 1.60, P=NR)Fair
Etanercept vs. Infliximab
Geborek et al., 200267Nonrandomized, open-label trial
369
1 year
Population-based; active RA; had failed at least 2 DMARDs; mean disease duration 14.5 yearsETN (25 mg twice weekly) vs. INF (3 mg/kg or higher)Higher ACR 20 responses for ETN at 3 (data NR; P<0.02) and 6 months (data NR; P<0.05); no significant differences in ACR response rates at 1 year (data NR)Fair
*Fernandez-Nebro et al., 200770Prospective cohort
161
6 years
Tertiary care center, Spain; Anti-TNF naïve patients; mean disease duration 9.5–9.9 yearsETN vs. INF (dosages NR)Significantly greater decrease t in DAS28 at 6 months for ETN vs. INF (−1.7 vs. −1.3; P=0.03); No difference in EULAR responses between ETN vs. INF at 6 monthsFair
*Hetland et al., 201073
DANBIO
Prospective cohort
2,326
6 monhs (48 months)
Patients with RA initiating therapy with biologic DMARDsADA (mean: 40 mg) wks) vs. ETN (mean 45 mg) vs. INF (mean 3.5 mg/kg)Higher achievement of ACR 70 response after 6 months for ETN vs. INF (OR 1.78, 95% CI, 1.28 to 2.50, P=NR)Fair
*Kievit et al., 200871Prospective cohort
707
1 year
Population-based, Netherlands, Anti-TNF naïve patients, failed at least 2 DMARDs; mean disease duration 6–7.7 yearsETN vs. INF (dosages NR)Greater decrease in DAS28 for ETN vs. INF at 1 year (ETN −1.8, INF −1.2; P<0.05)Fair
Kristensen et al., 200269Prospective cohort
949
3 years
Population-based, Inadequate response to at least 2 DMARDsETN (25 mg twice weekly) vs. INF (3 mg/kg or higher)No difference in ACR 50 response at 3 years (data NR)Fair
Weaver et al., 200668Prospective cohort
1,371
1 year
Population-based; patients with active RA who required change in therapy; mean disease duration 9.3 yearsETN (25 mg twice weekly) vs. INF (3.8 mg/kg or higher)Higher ACR 20 response rates for ETN than INF at 1 year (41% vs. 26%; P=NR)Fair
Rituximab vs. Anti-tumor Necrosis Factor Therapies
*Finckh et al., 200772Prospective cohort
116
6 months
Population-based, Switzerland; Patients who have failed at least 1 Anti-TNF treatment; mean disease duration 9–10 yrsRTX (2 infusions, 1000 mg) vs. anti-TNF agent (INF, ETN or ADA, dosages NR)Greater reduction in DAS28 at 6 months for RTX vs. Anti-TNF (−1.6 vs. −0.98; P=0.01)Fair
*

New study added since last review.

ACR = American College of Rheumatology; ADA = adalimumab; ATTEST = Abatacept or infliximab vs. placebo, a trial for tolerability, efficacy, and safety in treating rheumatoid arthritis; CI = confidence interval; DAS = disease activity score; DMARD = disease modifying antirheumatic drug; ETN = etanercept; INF = infliximab; mg/kg = milligram/kilogram; mACR = modified American College of Rheumatology; NR = not reported; NS = not significant; PCS = physical component score; RA = rheumatoid arthritis; TNF = tumor necrosis factor; US = United States; vs. = versus

New study added since last review.

From: Results

Cover of Drug Therapy for Rheumatoid Arthritis in Adults: An Update
Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet].
Comparative Effectiveness Reviews, No. 55.
Donahue KE, Jonas DE, Hansen RA, et al.

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