Comparación indirecta de los efectos de los agentes biológicos anti-TNF en pacientes con espondilitis anquilosante, mediante una comparación tratamiento mixto realizado en los datos de eficacia de los ensayos controlados aleatorios publicados

Objectives: To compare ASAS (Assessment in Ankylosing Spondylitis Response Criteria) 20 response patterns between anti-TNF biological agents in patients with ankylosing spondylitis by means of a mixed treatment comparison of different randomised, controlled trials (RCTs) on the efficacy of biological therapies. Methods: A systematic review of literature was performed to identify a number of similarly designed double-blind, randomized, placebo-controlled trials investigating the efficacy of the TNF-alfa inhibitors etanercept, infliximab, golimumab, certolizumab pegol and adalimumab in the treatment of ankylosing spondylitis patients, conducted over an 18-years period. The endpoint of interest was ASAS20 response criteria at 12 weeks. Results were analyzed simultaneously using Bayesian mixed treatment comparison techniques. Results were expressed as odds ratio (OR) of ASAS20 response and associated 95% credible intervals (CrIs). The probability of being the best treatment was also reported. Results: 6 RCTs were selected for data extraction and further analysis. By mean of MTC, all anti-TNF agents demonstrated to be more efficacious in inducing a ASAS20 response than placebo. Infliximab shows a 67,6% of probability of being the best treatment of all. Adalimumab, golimumab and etanercept show probabilities of 17,7%, 10,6% and 4%, respectively, while certolizumab pegol showed a probability of being the best treatment of 0,1%. No differences were observed when comparing directly an anti-TNFalfa agent against another. Conclusions: Even if the mixed treatment comparisons between infliximab, golimumab, certolizumab pegol, adalimumab and etanercept did not show a statistically significant difference, this analysis suggests that infliximab, compared to placebo, is expected to provide the highest rate of ASAS20 response in SA patients naive to biologic treatments.