TABLE 19Comparison of industry and Assessment Group evidence syntheses

Interventions: etanercept, infliximab, adalimumab
Abbott151Schering-Plough152Wyeth153Assessment team (York)
Studies used in the analysisMease 2000,78 Antoni 2003,117 Mease 2004,52,97,99,105,107,110 Antoni 2005,82 Kaltwasser 2004,62 Mease 2005,51 Mease 2006,97 Genovese 2007,83 Kavanaugh 2009,154 Gottlieb 2009155IMPACT,7981,89,96,109,111,113115,117,118 IMPACT 2,82,90,91,95,98,106,112,116 Mease 2000,78 Mease 2004, 52,97,99,105,107,110 ADEPT,51,88,92,93,100104 Genovese 2007,83 York HTA,73 GO-REVEAL156Mease 2004, 52,97,99,105,107,110 PRESTA,157 ADEPT,51,88,92,93,100104 IMPACT 2,82,90,91,95,98,106,112,116 STA ADL74IMPACT 7981,89,96,109,111,113115,117,118 IMPACT 2,82,90,91,95,98,106,112,116 Mease 2000,78 Mease 2004, 52,97,99,105,107,110 ADEPT,51,88,92,93,100104 Genovese 200783
Outcomes of interestPsARC12 and 24 weeks (24-week results estimated based on the conditional 12 weeks)12 or 14 weeks12 and 24 weeks; derived from STA ADL7412 weeks
HAQ12 weeks (dependent on ACR response type via multivariate regression)Weeks 12 and 24 for adalimumab; week 14 or 16 for infliximab; week 12 for etanercept (conditional on PsARC response)Derived from Mease 2004; changes in HAQ were predicted via PASI; assumed equal magnitude of change in HAQ for all three biologicsHAQ at 12 weeks conditional on PsARC response at 12 weeks (by biologic)
PASI 25/50/7512 and 24 weeks (independently modelled for both 12 and 24 weeks)Week 24 for adalimumab; week 14 or 16 for infliximab; week 24 for etanerceptPASI 75 only (12 and 24 weeks); derived from STA ADL74 and Mease 2004PASI 50/70/90 at 12 weeks (by biologic)
ACR 20/50/7012 and 24 weeks (24 week results estimated based on the conditional 12 weeks)Not estimatedNot estimatedACR 50/70/90 at 12 weeks (by biologic)
ModelBivariate probit model; Bayesian fixed-effects meta-analysis of bivariate ordinal dataTwo joint meta-analyses: PsARC/HAQ and PASIModel used not reported; the results were taken from a published evidence synthesis74Fixed-effects meta-analysis (PsARC, HAQ, ordered logit model PASI/ACR)
Results reportedPsARC, ACR and PASI responses at 12 and 24 weeks: estimated means of marginal probabilities. Joint distribution of PsARC and ACR response at 12 weeks. Joint distribution of PASI 75 at 12 and 24 weeksIncremental HAQ change given PsARC response in treatment; incremental HAQ change given PsARC non-response in treatment; incremental HAQ change given PsARC response in placebo; incremental HAQ change given PsARC non-response in placeboPsARC (% patients), PASI 75, HAQ change from baseline, change in PASIProbability of response in terms of PsARC, ACR and PASI; changes in HAQ given PsARC response/non-response to treatment
CommentsResults ‘borrow’ information from trials of therapies not of interest (golimumab, leflunomide, alefacept and ustekinumab)It was not possible to fully assess the results of the evidence synthesis performed as no details were provided even in the original publication159

ADL, adalimumab; GO-REVEAL, Golimumab-Randomized Evaluation of Safety and Efficacy in Subjects with Psoriatic Arthritis Using a Human Anti-TNF Monoclonal Antibody; PRESTA, Psoriasis Randomized Etanercept STudy in Subjects with Psoriatic Arthritis.

From: 3, Assessment of clinical effectiveness

Cover of Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation
Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation.
Health Technology Assessment, No. 15.10.
Rodgers M, Epstein D, Bojke L, et al.
Southampton (UK): NIHR Journals Library; 2011 Feb.
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