Infliximab superior to TNFi in treatment of patients with ankylosing spondylitis
Compared to other tumour necrosis factor–α inhibitors (TNFi), infliximab remains superior in reducing Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at 12 weeks, results of a network meta-analysis (NMA) have shown. However, it was sensitive to inclusion of an open-label trial, and its efficacy faded at 24 weeks.
A total of 20 trials of six TNFi, with 43 treatment arms and 3,220 participants, were included in this NMA. All TNFi were significantly better than placebo in reducing BASDAI and Bath Ankylosing Spondylitis Functional Index (BASFI) at 12 and 24 weeks.
All study drugs, except for certolizumab pegol (CZP), were statistically better than placebo in reducing C-reactive protein (CRP) levels at 12 weeks, and all TNFi but CZP and infliximab-dyyb (biosimilar) were significantly better than placebo in reducing CRP levels at 24 weeks.
Infliximab appeared to be superior to all other TNFi in reducing BASDAI at 12 weeks, but not at 24 weeks. No significant differences were observed among TNFi, excluding one open-label trial.
“The analysis was limited by few direct comparison trials,” according to the investigators. “Further study of relative safety and long-term effectiveness will help inform the choice of TNFi in treating active AS.”
To compare the efficacy of six TNFi in treatment of AS at 12 and 24 weeks, the investigators performed a systematic literature review of randomized controlled trials of TNFi in patients with AS. Included were trials that reported efficacy at 10–14 weeks (12-week analysis) and at 24–30 weeks (24-week analysis). The Bayesian NMA was used to compare the relative efficacy of all TNFi to improve the BASDAI, BASFI and CRP level.