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Comparison of the efficacy and safety of tocilizumab, sarilumab, and olokizumab in patients with active rheumatoid arthritis: a network meta-analysis of randomized controlled trials

Vergleich der Wirksamkeit und Sicherheit von Tocilizumab, Sarilumab und Olokizumab bei Patienten mit aktiver rheumatoider Arthritis: Netzwerk-Metaanalyse von randomisierten kontrollierten Studien

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Abstract

Objective

This study compared the relative efficacy and safety of olokizumab, tocilizumab, and sarilumab in rheumatoid arthritis (RA) patients who were intolerant or responding inadequately to methotrexate (MTX).

Methods

We performed a Bayesian network meta-analysis to combine direct and indirect evidence from randomized controlled trials (RCTs) to examine the efficacy and safety of olokizumab, tocilizumab, and sarilumab in RA patients who were intolerant or responding inadequately to MTX.

Results

Six RCTs comprising 4439 patients met the inclusion criteria. Tocilizumab, sarilumab, olokizumab, and adalimumab treatments achieved a significant American College of Rheumatology 20% (ACR20) response rate compared with placebo. However, tocilizumab was associated with the most favorable surface area using the cumulative ranking curve (SUCRA) for the ACR20 response rate. The ranking probability based on the SUCRA indicated that tocilizumab treatment had the highest probability of providing the best ACR20 response rate, followed by sarilumab, olokizumab every 2 weeks (Q2W), olokizumab Q4W, adalimumab 40 mg, and placebo. The ACR50 and 70 response rates showed a distribution pattern similar to that of the ACR20 response rate. However, olokizumab Q4W had a higher ranking probability than olokizumab Q2W. The SUCRA rating showed that the placebo was the best intervention with the least adverse events (AEs) and withdrawal due to AEs, followed by interleukin‑6 inhibitors.

Conclusion

Tocilizumab, sarilumab, and olokizumab are more effective than adalimumab and have similar efficacy and safety in RA patients with inadequate responses to MTX.

Zusammenfassung

Ziel

In der vorliegenden Studie wurde die relative Wirksamkeit und Sicherheit von Olokizumab, Tocilizumab und Sarilumab bei Patienten mit rheumatoider Arthritis (RA) verglichen, bei denen eine Unverträglichkeit und unzureichende Therapieantwort auf Methotrexat (MTX) bestand.

Methoden

Es wurde eine Bayes-Netzwerk-Metaanalyse durchgeführt, um direkte und indirekte Evidenz aus randomisierten kontrollierten Studien (RCT) für die Untersuchung der Wirksamkeit und Sicherheit von Olokizumab, Tocilizumab und Sarilumab bei RA-Patienten zu kombinieren, bei denen eine Unverträglichkeit und unzureichende Therapieantwort auf Methotrexat (MTX) bestand.

Ergebnisse

Die Einschlusskriterien wurden von 6 RCT mit 4439 Patienten erfüllt. Unter Therapie mit Tocilizumab, Sarilumab, Olokizumab und Adalimumab wurde eine signifikante ACR20-Responserate (American College of Rheumatology 20 %) im Vergleich mit Placebo erzielt. Jedoch ging Tocilizumab mit der günstigsten SUCRA („surface area using the cumulative ranking curve“) für die ACR20-Responserate einher. Die Rankingwahrscheinlichkeit auf Grundlage der SUCRA zeigte, dass die Therapie mit Tocilizumab die höchste Wahrscheinlichkeit für die beste ACR20-Responserate aufwies, es folgten Sarilumab, Olokizumab alle 2 Wochen (Q2W), Olokizumab Q4W, Adalimumab 40 mg und Placebo. Die ACR50- und ACR70-Responseraten wiesen ein Verteilungsmuster auf, das dem der ACR20-Responserate ähnlich war. Allerdings bestand für Olokizumab Q4W eine höhere Rankingwahrscheinlichkeit als für Olokizumab Q2W. Das SUCRA-Rating ergab, dass Placebo die beste Intervention mit den wenigsten unerwünschten Ereignissen (AE) und Therapieabbruch aufgrund von AE war, es folgten Interleukin(IL)-6-Inhibitoren.

Schlussfolgerung

Tocilizumab, Sarilumab und Olokizumab sind wirksamer als Adalimumab und weisen eine ähnliche Wirksamkeit und Sicherheit bei RA-Patienten mit unzureichender Therapieantwort auf MTX auf.

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Authors and Affiliations

  1. Department of Rheumatology, Korea University College of Medicine, Seoul, Korea (Republic of)

    Young Ho Lee MD, PhD & Gwan Gyu Song

  2. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, 02841, Seongbuk-gu, Seoul, Korea (Republic of)

    Young Ho Lee MD, PhD

Authors
  1. Young Ho Lee MD, PhD
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Correspondence to Young Ho Lee MD, PhD.

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Conflict of interest

Y. Ho Lee and G. Gyu Song declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

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Ho Lee, Y., Gyu Song, G. Comparison of the efficacy and safety of tocilizumab, sarilumab, and olokizumab in patients with active rheumatoid arthritis: a network meta-analysis of randomized controlled trials. Z Rheumatol 83 (Suppl 1), 97–106 (2024). https://doi.org/10.1007/s00393-022-01315-0

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