The following is a summary of “Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis,” published in the July 2023 issue of Rheumatology by Pugliesi et al.
Researchers conducted a cohort study to compare the efficacy of Rituximab, Tocilizumab, and Abatacept in individuals with Rheumatoid Arthritis (RA) unresponsive to treatments with MTX or TNFi agents.
They combed through 6 databases until January 2023 to identify phase 2–4 RCTs that studied patients with RA resistant to MTX or TNFi therapy. These patients were treated with rituximab, abatacept, and tocilizumab (intervention arm) and were compared to control groups. Two investigators independently studied the data, aiming to achieve an ACR70 response as the primary objective.
The results showed 19 RCTs with 7,835 patients (1.2 years). Hazard ratios for ACR70 response at 6 months showed no significant difference among bDMARDs, but notable heterogeneity was observed. Three factors—baseline HAQ score, study duration, and frequency of TNFi treatment in the control arm—were tackled through multivariate meta-regression on ACR70 relative risk (RR). Results in heterogeneity decreased (I2 = 24%), and model explanatory power increased (R2 = 85%). Rituximab showed no change in ACR70 response likelihood compared to abatacept (RR = 1.773, 95%CI 0.113–10.21, P=0.765), while abatacept indicated an association with higher RR = 2.217 (95%CI 1.554–3.161, P<0.001) for ACR70 response than tocilizumab.
They concluded high heterogeneity in rituximab, abatacept, and tocilizumab, with abatacept potentially increasing ACR70 response chances.