Indirect comparison of the effects of anti-TNF biological agents in patients with Ankylosing Spondylitis by means of a Mixed Treatment Comparison performed on efficacy data from published randomised, controlled trials

Figures & data

Table 1.  Research terms and proceeding used in EMBASE and MEDLINE for literature search.

Etanercept or Adalimumab or Infliximab and Ankylosing Spondylitis	And Double blind	And ASAS
1022	69	10

Table 2.  Selected articles and data which were considered for further analysis. Length of study, number of patients included, demographic characteristics, different disease duration and eventual co-medications, severity of disease, and outcome measures were considered.

Clinical study Study duration Kind of Anti-TNF studied	Davis et al., 2003		ASSERT, 2005		ATLAS
	24 weeks		24 weeks		24 weeks
	Etanercept	Placebo	Infliximab	Placebo	Adalimumab	Placebo
Total number of randomized patients	277 Patients under active treatment completing the study (129 on 1138)	Patients taking placebo completing the study (120 on 139)	279 Patients under active treatment completing the study (199 on 201)	Patients taking placebo completing the study (75 on 79)	315 Patients under active treatment completing the study (195 on 208)	Patients taking placebo completing the study (101 on 107)
Female	24%	24%	21.9%	12.8%	24.5%	26.2%
	76%	76%	78.1%	87.2%	75.5%	73.8%
Male age (years)	42.1 ± ?	41.9 ± ?	40.0 ± ?	41.0 ± ?	41.7 ± 11.69	43.4 ± 11.32
	10.1 ± ?	10.5 ± ?	7.7 ± ?	13.2 ± ?	11.3 ± 9.99	10.0 ± 8.34
Disease duration	84%	84%	86.5%	88.5%	78.4%	79.4%
HLA-B27 positive	58.1 ± 1.5	59.6 ± 1.4	6.6 (0–10 range)	6.5 (0–10 range)	6.3 ± 1.7 (0-10 range)	6.3 ± 1.7 (0–10 range)
Mean BASDAI score	25.9 ± 1.8	25.4 ± 1.9	nd	nd	Nd	Nd
ESR (mm/h) at baseline	1.9 ± 0.2	2.0 ± 0.2	1.5 ± ?	1.7 ± ?	1.8 ± 2.2	2.2 ± 2.9
C-reactive protein level (mg/dl) at baseline % of Patients showing ASAS20 response (n)	57% (79)	22% (31)	61.2% (123)	19.2% (15)	51% (106)	19% (20)

Figure 1.  Graphical expression of MTC between Adalimumab, Etanercept and Infliximab against placebo and comparison of the three drugs between each other.

Table 3.  Fixed effects MTC showing Odds Ratio and Credible Intervals for comparison between Adalimumab, Etanercept, and Infliximab, and probability of being best treatment for each drug.

Fixed effects mixed treatment comparisons
Comparisons	Odds ratio	95% CI low	95% CI high	Probability best treatment of all treatment compared	Rank
Infliximab vs Placebo	6.88951	3.669297	13.46374	72.0%	1
Etanercept vs Placebo	4.953032	2.718282	8.16617	15.0%	2
Adalimumab vs Placebo	4.481689	2.637944	8.16617	13.0%	3
Etanercep vs Adalimumab	1.030455	0.496585	2.225541
Etanercep vs Infliximab	1.447735	0.67032	3.320117
Adalimumab vs Infliximab	1.491825	0.67032	3.490343