Comparative efficacy of biologic disease-modifying anti-rheumatic drugs for non-radiographic axial spondyloarthritis: A systematic literature review and Bucher indirect comparisons

Akkoç, Nurullah, Arteaga, Carlos H., Auteri, Simone E., Betts, Marissa, Fahrbach, Kyle, Kim, Mindy, Kiri, Sandeep, Neupane, Binod, Gaffney, Karl ORCID: and Mease, Philip J. (2023) Comparative efficacy of biologic disease-modifying anti-rheumatic drugs for non-radiographic axial spondyloarthritis: A systematic literature review and Bucher indirect comparisons. Rheumatology and Therapy, 10 (2). pp. 307-327. ISSN 2198-6576

[thumbnail of Akkoc_etal_2023_RT]
PDF (Akkoc_etal_2023_RT) - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (878kB) | Preview


Introduction: Biologic disease-modifying anti-rheumatic drugs (bDMARDs), including certolizumab pegol (CZP), are effective treatment options for the management of non-radiographic spondyloarthritis (nr-axSpA). In the absence of head-to-head comparisons in nr-axSpA, we conducted a systematic literature review (SLR) and indirect treatment comparison (ITC) to better understand the comparative efficacy of CZP vs. other bDMARDs. Methods: Literature searches were conducted in October 2020 in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in patients with nr-axSpA who had failed at least one non-steroidal anti-inflammatory drug and were treated with bDMARDs. Outcomes of interest included the Assessment of Spondyloarthritis international Society (ASAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI) and Disease Activity Index (BASDAI), and spinal pain score. Comparative efficacy was examined using a series of Bucher ITCs in subgroups matched by prior exposure to bDMARDs, disease duration, baseline C-reactive protein (CRP) levels/magnetic resonance imaging (MRI) status, and timepoints, to ensure comparability between studies. Results: At 12–16 weeks, treatment with CZP was significantly more likely to achieve ASAS20/40 response and ASDAS-inactive disease status vs. etanercept (ETN), ixekizumab (IXE), and secukinumab (SEC). CZP showed statistically significant improvement in BASDAI, BASFI, and total spine pain score over adalimumab (ADA), ETN, and IXE, and in BASFI over SEC. Among patients with objective signs of inflammation (OSI; elevated CRP levels and/or inflammation on MRI at baseline), CZP had a statistically significant advantage over ETN and SEC (with or without loading dose) in achieving ASAS40, whereas the comparisons with other bDMARDs did not show any statistically significant differences. Conclusion: In the overall matched population, CZP performed significantly better than most comparators in improving the clinical outcomes. Among patients with OSI, CZP was found to be superior to SEC (in the MRI−/CRP + and MRI + /CRP− subgroups) and ETN (in the MRI + /CRP− subgroup) and it was comparable to golimumab and IXE across the different OSI subgroups.

Item Type: Article
Additional Information: Funding Information: Funding for this study and its publication, including the journal’s Rapid Service Fee, were sponsored by UCB Pharma. Evidera received funding from UCB to perform SLR and NMA analysis under authors input and direction. Publisher Copyright: © 2023, The Author(s).
Uncontrolled Keywords: axial spondyloarthritis,biologic dmards,certolizumab pegol,efficacy,indirect treatment comparison,rheumatology,immunology and allergy ,/dk/atira/pure/subjectarea/asjc/2700/2745
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 01 Sep 2023 09:31
Last Modified: 01 Sep 2023 09:31
DOI: 10.1007/s40744-022-00522-0


Downloads per month over past year

Actions (login required)

View Item View Item