Background

The biologic disease‐modifying anti‐rheumatic drugs (DMARDs) are very effective in treating rheumatoid arthritis (RA), however there is a lack of head‐to‐head comparison studies.

Objectives

To compare the efficacy and safety of abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab in patients with RA.

Methods

This ‘Overview of Reviews’ was done by including all Cochrane Reviews on Biologics for RA available in The Cochrane Library. We included only data on standard dosing regimens for these biologic DMARDs from placebo‐controlled trials. The primary efficacy and safety outcomes were ACR50 and withdrawals due to adverse events. We calculated Odds Ratios (OR) for efficacy and safety outcomes and combined estimates of events across the placebo groups as the expected Control Event Rate (CER). Indirect comparisons of biologics were performed for efficacy and safety using a hierarchical generalized linear mixed model (GLMM) incorporating the most important study‐level characteristic (ie type of biologic) as a fixed factor and study and study* drug interaction as random factors.