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

Table 5 Meta-analysis of the outcomes for anti-tumor necrosis factor naïve patients

Intervention	Outcomes	Studies (references)	n	RR (95%CI)or other mesure	I2(%)	P value
IFX vs ETA	EULAR good response	5 (19, 21, 22, 27, 28)	2822	0.82 [0.62-1.09]	82	0.0001
	EULAR moderate response	4 (19, 21, 22, 28)	2366	0.90 [0.61-1.33]	90	< 0.00001
	EULAR no response	4 (19, 21, 22, 28)	2366	1.29 [1.09-1.53]	27	0.25
	DAS 28 remission	4 (21, 27, 28, 37)	1804	0.82 [0.70-0.95]	0	0.4
	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
	CDAI remission	3 (27, 28, 37)	1876	0.88 [0.72-1.08]	0	0.93
ADA vs ETA	EULAR good response	4 (20, 22, 27, 28)	1590	1.11 [1.00-1.23]	0	0.4
	EULAR moderate response	3 (20, 22, 28)	1178	1.01 [0.83-1.24]	19	0.29
	EULAR no response	3 (20, 22, 28)	1178	0.69 [0.53-0.89]	11	0.32
	DAS 28 remission	3 (27, 28, 37)	1380	1.03 [0.82-1.29]	37	0.21
	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
	HAQ reduction	2 (22, 25)	653	-0.07 [-0.16-0.03]	0	0.92
	CDAI remission	3 (27, 28, 37)	1601	1.02 [0.67-1.56]	72	0.03
IFX vs ADA	EULAR good response	3 (22, 27, 28)	1706	1.42 [1.18-1.72]	42	0.18
	EULAR moderate response	2 (22, 28)	1338	0.96 [0.58-1.59]	80	0.03
	EULAR no response	2 (22, 28)	1338	0.56 [0.45-0.69]	0	0.88
	DAS 28 remission	3 (27, 28)	1648	1.23 [0.95-1.59]	48	0.15
	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
	CDAI remission	3 (27, 28, 37)	1875	1.17 [0.75-1.82]	75	0.02

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; CDAI: Clinical disease activity; HAQ: Health assessment questionnaire; ACR: American College Rheumatology.