A systematic review and network meta-analysis of current and investigational treatments for active ankylosing spondylitis

• Published in: Clinical rheumatology 2020-08, Vol.39 (8), p.2307-2315
• Main Authors: Deodhar, A., Chakravarty, S. D., Cameron, C., Peterson, S., Hensman, R., Fogarty, S., Spin, P., Kafka, S., Nair, S., Gensler, L. S.
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Ankylosing spondylitis; Antibodies, Monoclonal; Arthritis; Bayes Theorem; Bayesian analysis; C-reactive protein; Clinical trials; Humans; Inflammatory diseases; Infliximab; Intravenous administration; Literature reviews; Medicine; Medicine & Public Health; Meta-analysis; Monoclonal antibodies; Network Meta-Analysis; Original; Original Article; Randomized Controlled Trials as Topic; Rheumatic diseases; Rheumatology; Spondylitis, Ankylosing - drug therapy; Statistical analysis; Therapies, Investigational; TNF inhibitors; Tumor Necrosis Factor Inhibitors - administration & dosage; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor necrosis factor-α
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-020-04970-3

Objective To compare the relative efficacy of current and investigational biologic and oral small molecule (OSM) treatments for active ankylosing spondylitis (AS). Methods A systematic literature review was conducted to identify all phase 2/3 randomized trials of interest in patients with AS. Outcomes assessed were ≥ 20% improvement in the Assessment of Spondyloarthritis International Society Criteria (ASAS20) and change from baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) and C-reactive protein (CRP) at weeks 12–16. Bayesian network meta-analyses were conducted for outcomes using a random effects model. Baseline-risk adjustment was also conducted to account for differences in placebo response across studies. Surface Under the Cumulative Ranking curve (SUCRA) values are reported, reflecting the relative probability that intervention was the best of all interventions. Results The investigational agent tofacitinib 5 mg was the top-ranked treatment (SUCRA, 93%) for ASAS20 response, followed by intravenous (IV) golimumab 2 mg/kg (90%). Golimumab IV 2 mg/kg and infliximab 5 mg/kg were the top two ranked treatments for change from baseline in BASFI (golimumab IV, 81%; infliximab, 80%) and change from baseline in CRP (infliximab, 90%; golimumab IV, 82%). Conclusions Two approved therapies (golimumab IV, infliximab) and one investigational product ranked highest for efficacy in AS. Key Points • Although golimumab IV, infliximab, and tofacitinib ranked highest for efficacy in AS, differences in efficacy between approved and investigational therapies were not statistically significant.