PHS4 - A Network Metanalysis To Compare Biologic Agents In The Treatment of Non-Radiographic Axial Spondyloarthritis

Abstract

The non-radiographic axial spondyloarthritis (nrAxSpA) is referred to patients who have a clinical picture of ankylosing spondylitis (AS) without exhibiting radiographic sacroiliitis. The clinical diagnosis should be based on clinical symptoms, HLA B27 status, and magnetic resonance imaging (MRI) of sacroiliac joints.. The prevalence of nrAxSpA is similar to that of AS. The rate of progression of nrAxSpA to the radiographic stage of disease (AS) ranges from 10% to 20% over 2 years. Current treatment strategies for nrAxSpA are the same as for AS including inhibitors of tumor necrosis factor-alpha This MTC looks to compare Certolizumab (CZP), etanercept (ETA), adalimumab (ADA) and Golimumab (GDL) in clinical efficacy on nrAxSpA to achieve ASAS 20. A systematic research for RCT involving Certolizumab, etanercept, adalimumab and Golimumab was conducted using databases (CENTRAL, CINAHL,Embase, HMIC, MEDLINE and PsycINFO). MTC results are reported as the relative risk of response (RR), intended as the capacity of achieving ASAS 20 for each Anti-TNF agent compared with placebo. Five RCTs were identified. Two trials compared ADA versus placebo and one trial for each one of Certolizumab,etanercept,andGolimumab. GDL had the highest probability (64,19%) of being the most effective treatmentin achieving ASAS 20 towards placebo, followed by ADA (22,87% probability), CZP (10,22% probability) and then ETA (2,72%). Comparisons among any anti-TNF agent against each other don’t give evidence for a statistically significant difference. The results of this MTC can suggest that GDL, compared to placebo, is expected to provide the highest rate of ASAS 20 in patients affected by nrAxSpA.