Table 6Summary of head-to-head studies in adult patients with rheumatoid arthritis

Author, yearStudy designNDurationComparisonsPrimary outcomeSecondary outcomesPopulationResultsQuality rating
Abatacept compared with infliximab
Schiff et al., 200839RCT43112 monthsAbatacept vs. infliximabDAS 28ACR 20/50/70, HAQ, SF-36Active RA for at least 1 year; had failed methotrexate treatment; mean disease duration: 7.9 yearsGreater response rates with abatacept than with infliximab at study endpointFair
Adalimumab compared with etanercept
Hetland et al, 201045Prospective cohort study (DANBIO registry)96912 monthsAdalimumab vs. etanerceptACR 70EULAR, DAS28Population-based; active RA; started a biologic; mean disease duration: 8.5 yearsTreatment response similar for adalimumab and etanerceptFair
Kievit et al., 200844Prospective cohort study (DREAM registry)55612 monthsAdalimumab vs. etanerceptDAS 28SF-36Population-based; active RA; started a biologic; mean disease duration: 6.5 yearsDAS 28 and SF-36 physical component statistically similar between adalimumab and etanerceptGood
Adalimumab compared with infliximab
Hetland et al, 201045Prospective cohort study (DANBIO registry)145212 monthsAdalimumab vs. infliximabACR 70EULAR, DAS28Population-based; active RA; started a biologic; mean disease duration: 8.5 yearsStatistically significantly better response rates on ACR and EULAR for adalimumab than infliximabFair
Kievit et al., 200844Prospective cohort study (DREAM registry)41812 monthsAdalimumab vs. infliximabDAS 28SF-36Population-based; active RA; started a biologic; mean disease duration: 6.5 yearsImprovements on DAS 28 and SF-36 physical component statistically significantly better for adalimumab than for infliximabGood
Etanercept compared with infliximab
De Filippis et al, 200641Open-label randomized controlled trial3212 monthsEtanercept vs. InfliximabACR 20ACR 50/70, HAQActive RA for at least 2 years; had failed methotrexate treatment; mean disease duration: NRACR response rates and HAQ higher for etanercept than for infliximab at 12 monthsFair
Fernandez- Nebro et al., 200746Prospective cohort study1396 monthsEtanercept vs. infliximabDAS 28, EULARHAQActive RA ; had failed DMARD treatment; mean disease duration: 9.7 yearsDAS 28 was statistically significantly better for etanercept than infliximabFair
Geborek et al. 200240Non-randomized trial30112 monthsEtanercept vs. infliximabACR 20/50DAS28Population-based; active RA; had failed at least 1 DMARD treatment; mean disease duration: 14.5 yearsACR 20 response rates statistically significantly greater for etanercept than for infliximab at 3 months and 6 months ; no differences at 12 monthsFair
Hetland et al, 201045Prospective cohort study (DANBIO register)133312 monthsEtanercept vs. infliximabACR 70EULAR, DAS28Population-based; active RA; started a biologic; mean disease duration: 8.5 yearsStatistically significantly better response rates on ACR and EULAR for etanercept than infliximabFair
Hyrich et al, 200648Prospective cohort study (UK registry)36946 monthsEtanercept vs. infliximabEULARDAS 28Population-based; active RA; started a biologic; mean disease duration: 14.6 yearsEULAR response rates numerically greater for etanercept than for infliximab at 6 monthsFair
Kievit et al., 200844Prospective cohort study (DREAM registry)44012 monthsEtanercept vs. infliximabDAS 28SF-36Population-based; active RA; started a biologic; mean disease duration: 6.5 yearsDAS 28 and SF-36 physical component statistically significantly better for etanercept than infliximab (P<0.001)Good
Kristensen et al. 200643Prospective cohort study (Swedish registry)9493 yearsEtanercept vs. infliximabEULARACR 20/50/70Population-based; active RA; started a biologic; mean disease duration: 13.4 yearsModerate EULAR and ACR response rates numerically greater for etanercept than for infliximab at 3 yearsFair
Weaver et al. 200642Prospective cohort study (US registry)369412 monthsEtanercept vs. infliximabACR 20HAQPrimary-care based; active RA; patients who needed change in treatment regimen; mean disease duration: NRACR 20 response rates numerically greater for etanercept than for infliximab at 12 monthsFair
Combination strategies
Genovese et al., 200450RCT24224 weeksEtanercept + methotrexate vs. etanercept + anakinra + methotrexateACR 50ACR 20/70, SF-36> 6 months history of active RA; stable methotrexate regimen; mean disease duration: 10 yearsNo additional benefit from etanercept- anakinra combination therapy; Adverse events rates statistically significantly higher in combination than in etanercept groupFair
Weinblatt et al., 200751RCT1216 monthsAbatacept + etanercept vs. etanerceptACR 20ACR 50/70, HAQChronic RA: on etanercept for at least 3 months; mean disease duration: 12.9 yearsNo additional benefit from abatacept-etanercept combination therapy; Adverse events rates statistically significantly higher in combination than in abatacept groupFair

Abbreviations: ACR 20/50/70, American College of Rheumatology, numbers refer to percentage improvement; ASHI, arthritis-specific health index; DAS28, disease activity score28; DANBIO, Danish Biological; DMARD, disease-modifying antirheumatic drug; DREAM, Dutch Rheumatoid Arthritis Monitoring; EULAR, European League Against Rheumatism; HAQ, Health Assessment Questionnaire; RA, rheumatoid arthritis; RCT, randomized controlled trial; SF-36, Short Form 36 Health Survey.

From: RESULTS

Cover of Drug Class Review: Targeted Immune Modulators
Drug Class Review: Targeted Immune Modulators: Final Update 3 Report [Internet].
Thaler KJ, Gartlehner G, Kien C, et al.
Portland (OR): Oregon Health & Science University; 2012 Mar.
Copyright © 2012, Oregon Health & Science University, Portland, Oregon.

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