Biologics or Tofacitinib for People with Rheumatoid Arthritis Naïve to Methotrexate: a Systematic Review and Network Meta-analysis

Cochrane Database Syst Rev. 2017 May 8;5:CD012657. doi: 10.1002/14651858.CD012657

This Cochrane systemic review and network meta-analysis looked at the benefits and harms of biologics or tofacitinib in patients with RA not previously treated with MTX.Using data from 19 RCTs including 6,485 participants, the review found that biologics (abatacept, adalimumab, etanercept, golimumab, infliximab, rituximab) in combination with MTX improved signs and symptoms of RA (ACR50) and increased the chances of remission (DAS <1.6 or DAS28 <2.6). There was also some evidence of an improvement in physical function (HAQ score), but no significant effect on radiographic progression. Biologics in combination with MTX seem to make little or no difference to the risk of SAEs; the results were inconclusive for withdrawals due to AEs.TNF biologics (adalimumab, etanercept, golimumab) alone (without MTX) probably make little or no difference versus MTX in signs and symptoms of RA or chances of RA remission in MTX-naïve patients.