What is the best biological treatment for rheumatoid arthritis? A systematic review of effectiveness

Table 4 Meta-analysis of the outcomes for patients with treatment-naïve and therapeutic failure

Intervention	Outcomes	Studies (references)	Partici-pants	Relative risk (95%CI) or other mesure	I2(%)	P value
IFX vs ETA	EULAR good response	10 (18,19,21,22,24, 26,27, 28, 32,42)	7247	0.86 [0.72-1.02]	76	< 0.0001
	EULAR moderate response	9 (18,19,21,22,24, 26, 28, 32,42)	6791	0.98 [0.84-1.15]	78	< 0.0001
	EULAR no response	9 (18,19,21,22,24, 26, 28, 32,42)	6791	1.20 [1.05-1.38]	46	0.06
	DAS 28 remission	7 (21,26,27,28,32,37,42)	2868	0.70 [0.59-0.84]	0	0.51
	DAS 28	2 (21,26)	196	0.40 [-0.27- 1.07]	59	0.12
	DAS 28 reduction	2 (15,22)	1321	0.40 [0.04-0.77]	77	0.04
	CDAI remission	4 (27,28,37,42)	2293	0.90 [0.74-1.09]	0	0.89
	SDAI remission	2 (27,42)	840	0.87 [0.61-1.26]	0	0.9
	HAQ	3 (21,26,39)	495	0.14 [0.00-0.27]	0	0.51
	ACR 20	2 (19,37)	1309	0.95 [0.86-1.06]	0	0.47
	ACR50	3 (19,28,37)	2315	0.92 [0.81-1.03]	10	0.33
	ACR70	3 (19,28,37)	2315	0.88 [0.57-1.36]	79	0.009
ADA vs ETA	EULAR good response	8 (20,22,24,26,27,28,32,42)	2492	0.97 [0.79-1.20]	73	0.0005
	EULAR moderate response	7 (20,22,24,26,28,32,42)	2080	1.00 [0.89-1.12]	0	0.48
	EULAR no response	7 (20,22,24,26,28,32,42)	2080	0.90 [0.62-1.32]	76	0.0003
	DAS 28 remission	6 (26,27,28,32,37,42)	2412	0.93 [0.68-1.26]	80	0.0001
	DAS 28	2 (20,26)	180	-0.09 [-0.25-0.06]	0	0.73
	DAS 28 reduction	2 (15,22)	1392	0.17 [-0.19-0.52]	68	0.08
	CDAI remission	4 (27,28,37,42)	1883	1.16 [0.77-1.74]	70	0.02
	SDAI remission	2 (27,42)	641	1.40 [0.76-2.59]	55	0.13
	HAQ	2 (26,39)	339	-0.15 [-0.39-0.10]	49	0.16
	HAQ reduction	2 (22,25)	653	-0.07 [-0.16-0.03]	0	0.92
	ACR 20	2 (20,37)	445	0.89 [0.71-1.12]	0	0.68
	ACR 50	3 (20,28,37)	1217	1.09 [0.91-1.31]	18	0.3
	ACR 70	3 (20,28,37)	1436	1.15 [0.92-1.43]	0	0.82
IFX vs ADA	EULAR good response	8 (22,23,24,26,27,28,32,42)	3025	1.25 [1.06-1.47]	57	0.02
	EULAR moderate response	7 (22,23,24,26,28,32,42)	2657	0.91 [0.79-1.04]	31	0.19
	EULAR no response	7 (22,23,24,26,28,32,42)	2657	0.77 [0.56-1.05]	75	0.0006
	DAS 28 remission	6 (26,27,28,32,37,42)	2760	1.15 [0.91-1.46]	63	0.02
	DAS 28 reduction	2 (15,22)	1097	-0.24 [-0.96-0.48]	91	0.001
	CDAI remission	4 (27,28,37,42)	2332	1.30 [0.90-1.88]	68	0.02
	SDAI remission	2 (27,42)	765	1.66 [0.94-2.93]	61	0.11
	HAQ	2 (26,39)	182	-0.33 [-0.53-0.13]	0	0.92
	ACR 50	2 (28,37)	1458	1.14 [0.71-1.84]	79	0.03
	ACR 70	2 (28,37)	1458	1.41 [0.81-2.44]	72	0.06

A value of I² > 40% indicates statistical heterogeneity between the studies. A value of P < 0.10 from the chi-square test indicates statistical heterogeneity between the studies. CI: Confidence interval; ADA: Adalimumab; ETA: Etanercept; IFX: Infliximab; EULAR: European League Against Rheumatism; DAS 28: Disease activity score; SDAI: Simplified disease activity index; CDAI: Clinical disease activity; HAQ: Health Assessment Questionnaire; ACR: American College Rheumatology.