A Cochrane review [Abstract] 1 included 6 available Cochrane reviews from which, data were obtaines from 7 studies on abatacept, 8 on adalimumab, 5 on anakinra, 4 on etanercept, 4 on infliximab, and 3 on rituximab. The primary efficacy and safety outcomes were ACR50 (American College of Rheumatology Criteria) and withdrawals due to adverse events. The indirect comparison estimates showed similar efficacy for the primary efficacy outcome for all biologics with three exceptions. Anakinra was less efficacious than etanercept (with a ratio of RRs of 0.44 (95% CI 0.23 to 0.85); anakinra was less efficacious than rituximab, 0.45 (95% CI 0.22 to 0.90); and likewise adalimumab was more efficacious than anakinra, 2.34 (95% CI 1.32 to 4.13). In terms of safety, adalimumab was more likely to lead to withdrawals compared to etanercept, with a ratio of ORs of 1.89 (95% CI 1.18 to 3.04); anakinra more likely than etanercept, 2.05 (95% CI 1.27 to 3.29); and likewise etanercept less likely than infliximab, 0.37 (95% CI 0.19 to 0.70).
Comment: The quality of evidence is downgraded by study quality and by indirectness (only indirect comparisons).
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