- What is the clinical effectiveness of adalimumab versus other bDMARDs and tofacitinib in adult patients with rheumatological disorders?
Eight systematic reviews (SRs) provided direct and indirect comparative evidence of the clinical effectiveness of adalimumab compared to other biological Disease modifying Anti Rheumatic Drugs (DMARDs) and tofacitinib in adults with rheumatological disorders. Among them, four SRs considered patients with rheumatoid arthritis, three SRs considered patients with ankylosing spondylitis (AS) and one SR considered patients with psoriatic arthritis (PsA). No primary randomized controlled studies directly comparing adalimumab with other bDMARDs were identified.
In patients with RA, who were intolerant or inadequately responding to conventional DMARDS, the direct comparative evidence suggested that adalimumab was not superior to tocilizumab and sarilumab. The indirect comparison evidence suggested that adalimumab was no different in clinical efficacy when compared to etanercept, certolizumab pegol, and tofacitinib, but was less favoured when compared to tocilizumab and sarilumab. No evidence was found comparing the clinical efficacy of adalimumab compared to infliximab, golimumab and abatacept. Adalimumab was also found to have a similar safety profile compared to the other biological DMARDs.
In patients with PsA, no direct comparative evidence was found. Evidence from indirect comparisons suggested that adalimumab was superior to ixekizumab in achieving clinical response measured using American College of Rheumatology response, but no differences were found in Psoriatic Area severity index between the two drugs. No differences in clinical effectiveness were found between adalimumab and infliximab, etanercept, certolizumab pegol, secukinumab and golimumab. Adalimumab was also found to have fewer adverse events, but similar serious adverse events compared to the other bDMARDs.
In patients with AS, no direct comparative evidence was found between adalimumab and bDMARDs. Evidence from the indirect comparisons suggested that secukinumab was favoured over adalimumab in achieving clinical response. No differences in clinical effectiveness were found between adalimumab and infliximab, etanercept, certolizumab pegol and golimumab. Adalimumab was also found to have no differences in serious adverse events compared to infliximab, etanercept, certolizumab pegol and golimumab.