Trial (reference) | Compared interventions | Trial design; Patient population | Inclusion criteria | Endpoints | Study period |
---|---|---|---|---|---|
 |  |  | Exclusion criteria |  |  |
Abatacept studies | Â | Â | Â | Â | |
PBO + MTX; ABA 10 mg/kg every four weeks + MTX | Phase 3 RCT; Active RA despite MTX | Met ACR criteria, > = 18 years, RA for > = 1 year, > = 10 SJC, > = 12 TJC, CRP > = 10.0 mg/L, MTX (≥ 15 mg/week) for ≥ 3 months with stable dose for 28 days prior to enrolment | ACR20 at six months; HAQ-DI (≥ 0.3); CFB in joint erosion score at one year | Nov '02 to Oct' 04; 52 weeks | |
 |  |  | Positive tuberculin skin test |  |  |
PBO + MTX; ABA 2 mg/kg every four weeks + MTX; ABA 10 mg/kg every four weeks + MTX | Phase 3 RCT; Active RA despite MTX. | Met ACR criteria, > = 10 SJC, > = 12 TJC, CRP > 1 mg/dl, MTX (10 to 30 mg/week) for > = 6 months with stable dose for 28 days prior to enrolment | ACR20 at six months | Date n/s; 52 weeks + 6 months | |
 |  |  | n/s |  |  |
ATTEST trial [15] | PBO + MTX; ABA 10 mg/kg every four weeks + MTX; INF 3 mg/kg every eight weeks + MTX | RCT, double-dummy, PBO and active (INF)-controlled; RA and MTX-IR | Met ACR criteria, > = 18 years, RA for > = 1 year, > 10 SJC, > 12 TJC, CRP > 1 mg/dl, MTX > 15 mg/week for > 3 months prior to randomisation, other DMARDs washed out | Reduction in DAS28 with abatacept vs placebo at six months | Feb '05 to June '06; 52 weeks PBO arm = PBO for six months followed by ABA |
 |  |  | Prior experience with abatacept or an other approved biologic RA therapy, failed on > 4 conventional DMARDs |  |  |
Adalimumab studies | Â | Â | Â | Â | |
ARMADA [25] | PBO + MTX; ADA 20 mg every other week + MTX; ADA 40 mg every other week + MTX; ADA 80 mg every other week + MTX | RCT; Active RA despite MTX | Met ACR criteria; > = 18 years, > 9 TJC, > 6 SJC, MTX for > = 6 months and stable weekly dose for > = 4 weeks before enrolment, failed treatment with > = 1 DMARD besides MTX, but not > 4 DMARDs | ACR20 | Date n/s; 24 weeks |
 |  |  | Prior anti-CD4 therapy or TNF-α antagonists, history of active listeriosis or mycobacterial infection, any major infection |  |  |
DE019 [24] | PBO + MTX; ADA 20 mg weekly + MTX; ADA 40 mg every other week + MTX | RCT; Active RA treated with MTX. | Met ACR criteria; > = 18 years, > = 9 TJC, > = 6 SJC, CRP > 1 mg/dl, either rheumatoid factor positivity or > = 1 joint erosion on radiographs of hands + feet, MTX for > = 3 months at stable dose of 12.5 to 25 mg/week for > = 4 weeks | ACR20 at week 24 | Date n/s; 52 weeks |
 |  |  | Prior anti-CD4 therapy or TNF antagonists; history of: other active inflammatory arthritide, active listeriosis/mycobacterial infection, lymphoma/leukemia within five years; any major infection |  |  |
Certolizumab Pegol studies | |||||
PBO + MTX; CZP 200 mg every other week + MTX; CZP 400 mg every other week + MTX | Phase 3 RCT; Active RA with MTX-IR | > = 18 years, active RA for > = 6 months + < 15 years, > = 9 TJC + SJC with either ESR > = 30 m/hour or CRP > 15 mg/l, MTX for > = 6 months with a stable dosage of > = 10 mg/week for > = 2 months. | ACR20 at week 24; mean CFB in modified total Sharp score at week 52 | Feb '05 to Oct' 06; 52 weeks. ACR20 non-responders at weeks 12 + 14 were withdrawn | |
 |  |  | History of: tuberculosis, malignancy; PPD positive skin test; biologic therapy within 6 months, prior failure to respond to anti-TNF agent |  |  |
PBO + MTX; CZP 200 mg every other week + MTX; CZP 400 mg every other week + MTX | Phase 3 RCT; Active RA despite > = 6 months of MTX | Met ACR criteria, > 18 years, RA > 6 months duration but < 15 years, MTX for > 6 months (stable dose > 10 mg/week for > 2 months at baseline) | ACR20 at week 24 | June '05 to Sept' 06; 24 weeks ACR20 non-responders at weeks 12 + 14 were withdrawn | |
 |  |  | Biologic agent in previous six months, severe reaction to biologic agents, no response to previous anti-TNF therapy, history of tuberculosis, PPD positive skin test |  |  |
Etanercept studies | Â | Â | Â | Â | |
Weinblatt et al. 1999 [32] | PBO + MTX; ETN 25 mg 2x week + MTX | Double-blind, randomised; Active RA despite > = 6 months of MTX | Met ACR criteria, > = 18 years, > = 6 SJC + TJC, MTX for > = 6 months at stable dose of 15 to 25 mg/week for last 4 weeks, discontinued sulfasalazine + hydroxychloroquine > = 2 weeks + DMARDs other than MTX > = 4 weeks prior to study | ACR 20 at 24 weeks | Date n/s; 24 weeks |
 |  |  | n/s |  |  |
PBO + MTX; ETN 25 mg 2x week; ETN 25 mg 2x week + MTX | Randomised, double-blind, parallel group study; RA patients with DMARD-IR | Met ACR criteria, > = 18 years, active disease for 6 months-20 years, > 10 SJC, > 12 painful joints, IR to > = 1 DMARD other than MTX, previous MTX (without toxic effects/lack of response), no MTX within 6 months of enrolment | ACR response (ACR-N) AUC for the first 24 weeks | Oct '00 to July' 01; 52 weeks | |
 |  |  | Prior therapy with ETN or other TNF antagonists, immunosuppressive drugs within 6 months; investigational drug or biologic agent within 3 months, any other DMARDs or corticosteroid within 4 weeks, presence of relevant co morbidity |  |  |
Golimumab studies | Â | Â | Â | Â | |
PBO + MTX; GOL 100 mg every four weeks; GOL 50 mg every four weeks + MTX; GOL 100 mg every four weeks + MTX | Phase 3 RCT; active RA despite MTX | Met ACR criteria, > 18 years, RA > = 3 months, tolerated stable MTX dose of 15-25 mg/week for > = 3 months prior to screening, > = 4 SJC & TJC, met the tuberculosis screening criteria | ACR20 at week 14 and improvement from baseline in HAQ-DI score at week 24. | Dec '05 to Sept' 07; 52 weeks. At week 16, patients < 20% CFB in TJC and SJC had medication adjusted | |
 |  |  | Hypersensitivity to GOL, previous anti-TNF agent, RTX, natalizumab, cytotoxic agents, anakinra, DMARDs other than MTX, corticosteroids within four weeks, alefacept or efalizumab within three months. |  |  |
Infliximab studies | |||||
PBO + MTX; INF 3 mg/kg every eight weeks + MTX; INF 3 mg/kg every four weeks + MTX; INF 10 mg/kg every eight weeks + MTX; INF 10 mg/kg every four weeks + MTX | International Phase 3 RCT; Active RA despite MTX | Met ACR criteria, > = 6 SJC + TJC, MTX for > = 3 months not stopped for > 2 weeks, MTX at stable dose > 12.5 mg/week for > = 4 weeks, oral corticosteroids or NSAIDs on stable dose for > = 4 weeks | ACR20 at week 30 | Date n/s; 54 weeks | |
 |  |  | DMARD (not MTX) or non-oral corticosteroids in four weeks before screening, alkylating agents, any other agent to reduce TNF, allergic to murine proteins, serious infections in previous three months, chronic infectious disease |  |  |
Rituximab studies | Â | Â | Â | Â | |
PBO + MTX; RTX 500 mg x2 injections + MTX; RTX 1,000 mg x2 injections + MTX | Phase 2b international RCT, double-dummy; Active RA with DMARD-IR and MTX-IR. | Met ACR criteria, 19 to 79 years, RA > 6 months, MTX at 10 to 25 mg/week for > = 12 weeks before randomization, stable dose for last 4 weeks, > 8 SJC + TJC, either ECR > = 28 mm/hour or CRP > = 1.5 mg/dl, IR to 1 to 5 DMARDs (other than MTX) and/or biologic agents discontinued > = 4 weeks before randomization and INF, ADA, leflunomide > = 8 weeks before randomization | ACR20 for RF-positive patients at week 24 | Date n/s; 24 weeks | |
 |  |  | Significant systemic involvement secondary to RA, other illnesses or laboratory abnormalities, severe allergic or anaphylactic reactions to monoclonal antibodies, previous treatment with RTX or any lymphocyte-depleting therapies, recurrent significant infection |  |  |
 |  |  | N/S |  |  |
Strand et al. 2006 [41] | PBO + MTX; RTX 1,000 mg x2 injections; RTX 1,000 mg x2 injections + cyclophosphamide; RTX 1,000 mg x2 injections + MTX | RCT; Active RA despite MTX | Met ACR criteria, > 21 years, MTX > = 10 mg/week, > = 8 SJC + TJC, CRP > = 15 mg/l and/or ESR > = 28 mm/h, and/or morning stiffness > 45 minutes, plasma rheumatoid factor level > 20 IU/ml | ACR 50 at week 24 | Date n/s; 48 weeks |
 |  |  | Other autoimmune disease, ARA functional class IV disease, active rheumatoid vasculitis, history of systemic diseases associated with arthritis, chronic fatigue syndrome, serious and uncontrolled coexisting diseases |  |  |
PBO + MTX; RTX 500 mg x2 injections + MTX; RTX 1,000 mg x2 injections + MTX | Phase 3 RCT; Active RA with MTX-IR and naïve to prior biologic therapy | ≥ 8 SJC + TJC, elevated CRP (≥ 0.6 mg/dL) and/or ESR (≥ 28 mm/h) despite MTX for ≥ 12 wks | ACR20 at week 24 | Date n/s; 48 weeks | |
 |  |  | N/S |  |  |
Tocilizumab studies | Â | Â | Â | Â | |
PBO + MTX; TCZ 4 mg/kg every four weeks + MTX; TCZ 8 mg/kg every four weeks + MTX | Phase 3 RCT, parallel group; RA with MTX-IR | Met ACR criteria, adults, RA > 6 months, MTX-IR, > = 6 SJC, > = 8 TJC, CRP > 10 mg/L or ESR > = 28 mm/h, MTX for > = 12 weeks before start of study (stable dose of 10 to 25 mg/week for > = 8 weeks), discontinuation of other DMARDs: leflunomide > = 12 weeks, anakinra > = 1 week, etanercept > = 2 weeks, infliximab or adalimumab > = 8 weeks prior to start of study | ACR20 at 24 weeks | Date n/s; 24 weeks. At week 16, patients < 20% CFB in TJC and SJC were eligible for rescue therapy with TCZ 8 mg/kg | |
 |  |  | other autoimmune diseases, significant systemic involvement secondary to RA, functional class IV RA, inflammatory joint disease other than RA, recurrent infections, active liver disease, anti-TNF agent failure |  |  |
 |  |  | Not stated |  |  |
LITHE [42] | PBO + MTX; TCZ 4 mg/kg every four weeks + MTX; TCZ 8 mg/kg every four weeks + MTX | Phase 3 RCT, double-blind; RA with MTX-IR | N/S | CFB in Genant-modified Sharp score and AUC in the HAQ-DI at Week 52 | two years A switch to blinded rescue treatment was available at weeks 16 and 28, if required. |