Infliximab and etanercept in rheumatoid arthritis: systematic review of long-term clinical effectiveness, safety, and cost-effectiveness
Suarez-Almazor M, Ortiz Z, Lopez-Olivo M, Moffett M, Pak C, Skidmore B, Kimmel B, Kallen M, Cox V
Record ID 32007000135
English
Authors' objectives:
The objective of the report was to provide the best up-to-date evidence of the safety, long-term effectiveness, and costs of anti-TNF agents (etanercept (ETN; Enbrel), infliximab (IFX; Remicade), and adalimumab (ADM; Humira) in the treatment of Rheumatoid Arthritis (RA). Includes a systematic review of the literature that includes RCTs, observational studies, and economic evaluations from the time when anti-TNF agents were first available. Two questions are implied in the objective. : What is the evidence (clinical trials or observational studies) of the long-term effectiveness and safety of IFX and ETN for RA? : What is the evidence of cost-effectiveness for IFX and ETN for RA?
Authors' recommendations:
Implications for Decision Making;
: IFX and ETN are moderately effective at one year. Evidence suggests that IFX and ETN, used concomitantly with MTX, improve surrogate and composite outcomes, such as delay in radiological progression and American College of Rheumatology improvement criteria. The long-term impact on functionality, survival, or quality of life has not been demonstrated.
: Concerns remain regarding long-term harm. Evidence suggests that risks for some serious complications, such as tuberculosis and autoimmune disorders, are greater with IFX than with ETN. Half of patients receiving IFX and a third of patients receiving ETN discontinued therapy by the third year of treatment. Patients receiving therapy should be monitored.
: IFX and ETN are not cost-saving. Economic evidence suggests that ETN and IFX, when used concomitantly with MTX, is only costeffective for the treatment of RA after the failure of other DMARDs, and if society is willing to pay >100,000 Canadian dollars to obtain a quality adjusted life-year.
Authors' methods:
Systematic review, Cost study
Details
Project Status:
Completed
Year Published:
2007
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Antirheumatic Agents
Contact
Organisation Name:
Canadian Agency for Drugs and Technologies in Health
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Agency for Drugs and Technologies in Health (CADTH)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.