CMAJ • November 24, 2009; 181 (11). First published November 2, 2009; doi:10.1503/cmaj.091391
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Abstract
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Appendices
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Singh, J. A.
Right arrow Articles by Tugwell, P.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Singh, J. A.
Right arrow Articles by Tugwell, P.
Related Collections
Right arrowRelated Article

A network meta-analysis of randomized controlled trials of biologics for rheumatoid arthritis: a Cochrane overview

Jasvinder A. Singh, MD, Robin Christensen, PhD, George A. Wells, PhD, Maria E. Suarez-Almazor, MD, Rachelle Buchbinder, MD, Maria Angeles Lopez-Olivo, MD, Elizabeth Tanjong Ghogomu, MD and Peter Tugwell, MD

From the Department of Medicine (Singh), Minneapolis VA Medical Center and University of Minnesota, Minneapolis and Mayo Clinic College of Medicine, Rochester, USA; the Parker Institute: Musculoskeletal Statistics Unit (Christensen), Frederiksberg Hospital, Frederiksberg, Denmark; the Cardiovascular Research Reference Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; General Internal Medicine (Suarez-Almazor, Lopez-Olivo), Ambulatory Treatment and Emergency Care, University of Texas, M.D. Anderson Cancer Center, Houston, USA; the Monash Department of Clinical Epidemiology at Cabrini Hospital (Buchbinder), Department of Epidemiology and Preventive Medicine, Monash University, Malvern, Australia; and the Centre for Global Health (Ghogomu, Tugwell), Institute of Population Health, University of Ottawa, Ottawa, Ont.


View this table:
[in this window]
[in a new window]

  		Table 1: Characteristics of the inclusion criteria and the patient populations of the included reviews

 

Figure 16
View larger version (40K):
[in this window]
[in a new window]

  		Figure 1: Flow chart for selection of systematic reviews included in the overview of systematic reviews of biologics for treatment of rheumatoid arthritis.

 

View this table:
[in this window]
[in a new window]

  		Table 2: Summary of the findings of meta-analyses of biologics for rheumatoid arthritis

 

Figure 26
View larger version (12K):
[in this window]
[in a new window]

  		Figure 2: Comparison of each biologic to placebo for benefit (defined as a 50% improvement in patient- and physician-reported criteria of the American College of Rheumatology [ACR50]). A value greater than 1.0 indicates a benefit from the biologic. CI = confidence interval. For details of studies included for each biologic, refer to Appendix 2 (avaiable at www.cmaj.ca/cgi/content/full/cmaj.091391/DC1).

 

Figure 36
View larger version (13K):
[in this window]
[in a new window]

  		Figure 3: Comparison of each biologic to placebo for safety (deterined by number of withdrawals because of adverse events). A value less than 1.0 indicates a benefit from the biologic. CI = confidence interval. For details of the studies included for each biologic, refer to Appendix 2 (avaiable at www.cmaj.ca/cgi/content/full/cmaj.091391/DC1).

 

Figure 46
View larger version (23K):
[in this window]
[in a new window]

  		Figure 4: Indirect comparison of each biologic to each other for benefit (ACR50). A value greater than 1.0 indicate a benefit from the biologic. CI = confidence interval. I2 values for the studies are presented in Figure 2.

 

Figure 56
View larger version (22K):
[in this window]
[in a new window]

  		Figure 5: Indirect comparison of biologics to each other for safety (determined by number of withdrawals because of adverse events). A value greater than 1.0 indicate a benefit from the biologic. CI = confidence interval. I2 values for the studies are presented in Figure 2.

 

View this table:
[in this window]
[in a new window]

  		Table 3: Stratified meta-analyses for benefit and safety for biologics used in the treatment of rheumatoid arthritis