Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review
- 22 July 2016
- journal article
- research article
- Published by Wiley in Arthritis Care & Research
- Vol. 68 (8), 1078-1088
- https://doi.org/10.1002/acr.22815
Abstract
Objective: To systematically compare the risk of adverse events (AEs) for 13 targeted immunomodulators (TIMs) indicated for ankylosing spondylitis (AS), inflammatory bowel diseases, juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis (PsA), or rheumatoid arthritis (RA). Methods: We searched electronic databases through July 2015 to retrieve randomized controlled trials (RCTs) and observational studies comparing AEs between two or more TIMs head-to-head. We reported on the following outcomes: number of AEs, discontinuation due to AEs, serious AEs, mortality, serious infections, tuberculosis, herpes zoster, and malignancies. We qualitatively synthesized the literature and conducted random effects meta-analyses if three or more studies provided data for an outcome. Results: Ten head-to-head RCTs and 51 observational studies were included in this systematic review. A majority of the studies (70%) were conducted in RA patients. Risk of treatment discontinuation due to AEs was higher with infliximab than with adalimumab or etanercept in RA, PsA, and AS. A higher risk for serious infections was noted with infliximab than with abatacept, adalimumab, or etanercept in RA. Risk for treatment discontinuation due to AEs, serious infections, and tuberculosis was lower with etanercept than with adalimumab in RA. Limited evidence suggested no comparative differences in risk for mortality, malignancies, and herpes zoster for adalimumab, etanercept, and infliximab in RA. Conclusion: Important differences were noted in the safety profile of TIMs in RA, generally favoring abatacept, adalimumab, and etanercept over infliximab. Head-to-head comparative evidence for other TIMs and non-RA populations was insufficient to draw conclusions for most of the safety outcomes.Keywords
This publication has 47 references indexed in Scilit:
- Comparative Effectiveness of Immunosuppressants and Biologics for Inducing and Maintaining Remission in Crohn's Disease: A Network Meta-analysisGastroenterology, 2015
- Efficacy and safety of systemic treatments for moderate‐to‐severe psoriasis: meta‐analysis of randomized controlled trialsBritish Journal of Dermatology, 2014
- Systematic review, network meta-analysis and economic evaluation of biological therapy for the management of active psoriatic arthritisBMC Musculoskeletal Disorders, 2014
- Mixed treatment comparison of efficacy and tolerability of biologic agents in patients with rheumatoid arthritisCurrent Medical Research and Opinion, 2013
- Biologic therapy for autoimmune diseases: an updateBMC Medicine, 2013
- Mixed Treatment Comparison of the Treatment Discontinuations of Biologic Disease-Modifying Antirheumatic Drugs in Adults with Rheumatoid ArthritisAnnals of Pharmacotherapy, 2012
- Switch to adalimumab in patients with Crohn's disease controlled by maintenance infliximab: prospective randomised SWITCH trialGut, 2011
- A network meta-analysis of randomized controlled trials of biologics for rheumatoid arthritis: a Cochrane overviewCMAJ : Canadian Medical Association Journal, 2009
- Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and MalignanciesJama-Journal Of The American Medical Association, 2006
- Current methods of the U.S. Preventive Services Task Force: A review of the processAmerican Journal of Preventive Medicine, 2001