Adding Certolizumab to Conventional Treatment May Increase Probability of Low RA Activity

Addition of certolizumab to conventional antirheumatic treatment was associated with a greater chance of achieving a low level of disease activity among patients with rheumatoid arthritis (RA), according to results of a meta-analysis published in JAMA Network Open.

Investigators aimed to determine whether adding biologic agents to conventional antirheumatic drugs for RA treatment enhanced disease control.

The investigators searched Cochrane CENTRAL, Scopus, MEDLINE, and the World Health Organization International Clinical Trials Registry Platform for articles reporting the results of placebo-controlled randomized clinical trials (RCTs) of certolizumab added to conventional antirheumatic drugs.

The primary study outcome was low disease activity or disease remission after 3 months, as defined by 3 disease activity indexes: the Disease Activity Score based on the evaluation of 28 joints, the Clinical Disease Activity Index, or the Simplified Disease Activity Index.

The investigators used a two-stage model (penalized logistic regression and Bayesian individual participant data meta-regression) to estimate patient-specific outcomes from adding certolizumab to conventional antirheumatic drugs compared with using conventional drugs alone. Once these estimates were made, results were displayed interactively on an application.

A total of 5 RCTs comprised of data from 3790 patients were included in the analysis; 79.1% of the patients were women and the mean age was 52.7 years.

Meta-analysis of this data indicated that, generally speaking, adding certolizumab to conventional antirheumatic treatment was associated with a greater chance of achieving a low level of disease activity. For patients with average baseline expected probability of low disease activity or remission, the odds ratio of the outcome was 6.31 (95% credible interval, 2.22-15.25).

However, the benefits of adding certolizumab differed depending on baseline patient characteristics. More specifically, for patients with either low or high baseline expected probability of low disease activity or remission, the estimated risk difference was less than 10%.

This study was limited by the absence of several potential risk factors in the data set and a lack of precise data on the number of previous treatments attempted and responses to them. Moreover, the approach used for the meta-analysis could not identify individual prognostic factors and effect modifiers, and data availability bias may be present due to the small number of trials included in the analysis. Finally, certolizumab may not be representative of all biologic agents.

The study authors concluded, “Adding biologics was associated with an increased probability of reaching the treatment target for patients with moderate baseline risks. However, the benefit was limited for patients with very low or high baseline risks, for whom other evaluations may be necessary.”

Disclosure: One or more of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.