Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation

摘要: BACKGROUND: Etanercept, infliximab and adalimumab are licensed in the UK for treatment of active progressive psoriatic arthritis (PsA) adults who have an inadequate response to standard treatment. OBJECTIVE: To determine clinical effectiveness, safety cost-effectiveness these biologic agents PsA. DATA SOURCES: Systematic reviews were performed, with data sought from 10 electronic databases (MEDLINE, EMBASE, Cochrane Central Register Controlled Trials, Science Citation Index, Conference Proceedings Index - Science, ClinicalTrials.gov, metaRegister Current NHS Economic Evaluation Database, Health Evaluations Database EconLit) up June 2009. REVIEW METHODS: Full paper manuscripts titles/abstracts considered relevant obtained assessed inclusion by two reviewers according criteria on study design, interventions, participants outcomes. Data participant characteristics, efficacy outcomes, adverse effects, costs health service extracted, along baseline where reported. The primary outcomes measures anti-inflammatory response, skin lesion functional status, outcome was incidence serious events. measure incremental cost per additional quality-adjusted life-year (QALY). Standard meta-analytic techniques applied data. Published studies economic analyses submitted National Institute Clinical Excellence (NICE) manufacturers reviewed. An model developed updating produced York Assessment Group previous NICE appraisal biologics RESULTS: Pooled estimates effect demonstrated a significant improvement patients PsA all joint disease status at 12-14 weeks' follow-up. significantly reduced symptoms etanercept [relative risk (RR) 2.60, 95% confidence interval (CI) 1.96 3.45], (RR 3.44, CI 2.53 4.69) 2.24, 1.74 2.88), 24-week demonstrating maintained effects. Trial three 12 or 24 weeks. Evidence synthesis found that appeared be most effective across disease. greater than adalimumab, whereas etanercept, although differences not statistically significant. Under base-case assumptions, likely cost-effective strategy mild-to-moderate psoriasis if threshold �20,000 �30,000 QALY. All had similar probability being moderate-to-severe LIMITATIONS: Limited available difficulty assessing activity its therapy. CONCLUSIONS: indicated efficacious compared placebo, beneficial effects symptoms, skin. Short-term suggested can delay progression evidence support their use is convincing. Future research would benefit long-term observational large sample sizes demonstrate maintained, further monitoring profiles agents. FUNDING: Research Technology programme.