Efficacy of biologic agents in improving the Health Assessment Questionnaire (HAQ) score in established and early rheumatoid arthritis a meta-analysis with indirect comparisons
Efficacy of biologic agents in improving the Health Assessment Questionnaire (HAQ) score in established and early rheumatoid
arthritis: a meta-analysis with indirect comparisons
L. Barra1,2, A. Ha2,3, L. Sun2,4, C. Fonseca2,5, J. Pope1
Department of Medicine, Division of Rheumatology, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; 2School of Public Health, Harvard University, Cambridge, MA, USA; 3Department of Medicine, Division of Cardiology, The University of Toronto, Canada;
4Department of Anesthesia, University of Ottawa, Canada; 5Department of Neurology,
Universidade de Lisboa, Portugal.
1
Objective
The Health Assessment Questionnaire (HAQ) is a validated physical function measure. It is predictive for disability and mortality. The objective of this study was to determine the comparative efficacy of biologic agents in improving HAQ in
patients with established RA who failed DMARDs or anti-TNF agents and in early RA (ERA). Methods
We performed random effects meta-analyses of published randomised, placebo-controlled trials. Outcome was the mean difference in change in HAQ for biologic agents compared to controls ( HAQB- HAQC). Indirect comparisons of the different biologic drugs were conducted using the Q-test based on analysis of variance. Meta-regression was performed
using the method of moments. Results
Twenty-eight trials were included: 19 with DMARD-failures; 4 with anti-TNF-failures and 5 ERA. The following biologics were represented: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab. Efficacy of biologics at reducing HAQ was significantly different based on prior treatment (p=0.001). In RA patients with DMARD failures, HAQB- HAQC was -0.22; 95%CI: -0.24, -0.20 (I2=55%). Infliximab, abatacept and tocilizumab had lower HAQB- HAQC compared to other biologics (p<0.02). In anti-TNF-failures, HAQB- HAQC was -0.36; 95%CI: -0.42, -0.30 (I2=0%). In ERA, methotrexate-naïve trials, HAQB- HAQC was -0.19; 95% CI: -0.26, -0.13 (I2=0%).
There were no significant differences in the efficacy of different biologics for anti-TNF failures and ERA. Conclusions
Biologic agents were efficacious at lowering HAQ in RA. Differences between agents in RA with DMARD failures were less than the minimally clinically important difference for HAQ; therefore, the clinical significance of these differences
is unclear.
Key words
rheumatoid arthritis, physical function, meta-analysis, biologics, Health Assessment Questionnaire