PMS5 - A NETWORK META-ANALYSIS TO EVALUATE THE EFFICACY OF BARICITINIB AND OTHER TREATMENTS OF RHEUMATOID ARTHRITIS IN PATIENTS WHO ARE INADEQUATE RESPONDERS TO METHOTREXATE

Abstract

To assess the comparative effectiveness of baricitinib (BARI) 4-mg (background MTX) (oral, JAK 1/2 inhibitor) and other targeted synthetic/biologic disease modifying anti-rheumatic drugs in moderate-to-severe rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX-IR). A systematic literature review (SLR) of randomized controlled trials (RCTs-Phase 3) of interventions of interest was conducted (1999 to 2017) in Medline, Medline In-Process, Embase, Biosciences Information Service, the Cochrane Library, and trials registers. Network meta-analyses (NMAs) of RCTs reporting the American College of Rheumatology (ACR) response data were conducted using Bayesian mixed-treatment comparisons. Here we present main results for the 24-week (+/-4) timepoint (fixed effects simultaneous models). 24 trials met the SLR inclusion criteria. Analyses, using BARI RA-BEAM trial data, showed BARI 4-mg (background MTX) to be more effective than adalimumab (ADA) 40-mg (EOW) (Odds Ratio 1.33; 95%-Credible Interval 1.01-1.75), abatacept (ABA) 10-mg (IV/4weeks) (OR 1.47; 95%-CrI 1.02-2.13), infliximab (IFX) 3-mg (IV/8weeks) (OR 1.61; 95%-CrI 1.12-2.27) for ACR20. While no differences were found on ACR50, BARI 4-mg (background MTX) was found to be more effective than ADA 40-mg (OR 1.39; 95%-CrI 1.02-1.89), ABA 10-mg (OR 1.85; 95%-CrI 1.09-3.23), rituximab (RTX) 1000-mg (OR 2.38; 95%-CrI 1.10-5.00) and 2000-mg (OR 2.44; 95%-CrI 1.04-5.56) for ACR70. Bari 4 mg (background MTX) showed better results versus etanercept monotherapy (50mg/week or 25mg/biweekly) (OR 2.27; 95%-CrI 1.04-5.26) for ACR20, and RTX 1000-mg monotherapy for ACR20/ACR70 (OR 1.82; 95%-CrI 1.02-3.13)/(OR 2.70; 95%-CrI 1.04-7.14), respectively. Sensitivity analysis that included 10 additional trials with up to 20% of patients with prior biologic use allowed comparison versus tofacitinib (TOFA), showing BARI 4-mg (background MTX) to be more effective than TOFA 5-mg (BID) monotherapy for ACR20 (OR 1.92; 95%-CrI 1.32-2.86). The comparative analyses support BARI as an efficacious treatment option for moderate-to-severe RA patients with inadequate response to MTX.