Efficacy of biologic agents in improving the Health Assessment Questionnaire (HAQ) score in established and early rheumatoid arthritis a meta-analysis with indirect comparisons
Fig. 2.
Difference in mean change in HAQ in patients previously failing DMARD agents subsequently treated with biologic agents compared to control
Fig. 3. Difference in mean change in HAQ in patients previously failing anti-TNF agents subsequently treated with biologic agents compared to control.
als of other biologic therapies allowed for cross-over between study arms with intention-to-treat analysis, which could underestimate the effect of the biologic. We found that abatacept and tocili-zumab was not as effective at improv-ing HAQ in DMARD-failures over the time frame of the trials. However, some of the trials included patients pre-viously exposed to biologics (<10% of total subjects in a trial). HAQ improve-ment in the tocilizumab trial that only included patients with no prior anti-TNF exposure was higher than the oth-er tocilizumab trials and not different than the HAQ improvement seen with non-infliximab anti-TNF agents. This is consistent with the recently published RCT of tocilizumab versus adalimumab that reported no difference in change in HAQ for the 2 drugs (46).
With respect to abatacept, excluding trials that included patients previously exposed to biologics did not change re-sults. Salliot et al. also found that abata-cept was inferior to other biologics at achieving ACR50 (7). The ATTEST trial (47), a head-to-head RCT of abata-338
cept versus infliximab (3mg/kg every 8 weeks), did not find a difference be-tween these two biologic drugs, which is similar to our results given the infe-riority of infliximab compared to other anti-TNF agents. We were unable to analyse rituximab in the DMARD-fail-ure group because of incomplete HAQ data in those trials. The magnitude of the difference in HAQ improvement for abatacept, infliximab or tocilizumab compared to the other anti-TNF agents was <0.22, therefore, it may not be clin-ically significant.