Certolizumab pegol和secukinumab积极治疗银屑病关节炎疾病修饰治疗风湿病的药物反应不足:系统回顾和经济评价。

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Corbett M, Chehadah F, Biswas M, Moe-Byrne T,帕默年代,苏亚雷斯M,沃尔顿M,变硬,何鸿燊P, Woolacott N, Bojke L

Certolizumab pegol和secukinumab积极治疗银屑病关节炎疾病修饰治疗风湿病的药物反应不足:系统回顾和经济评价。

健康评估生物抛光工艺。2017年10月,21 (56):1 - 326。doi: 10.3310 / hta21560。

PubMed ID

28976302 (在PubMed

]

文摘

背景:有几个生物疗法批准的国家健康和保健研究所(NICE)对银屑病关节炎患者(PsA)两个或两个以上的合成反应不足的疾病修饰治疗风湿病的药物(DMARDs)。漂亮并不特别推荐从一个生物切换到另一个,而且只有ustekinumab(科大;STELARA ((R)),詹森制药,Inc .)、美国宾夕法尼亚州)霍舍姆建议抗肿瘤坏死因子后失败。Secukinumab(秒;COSENTYX ((R)),诺国际集团,瑞士巴塞尔)和certolizumab pegol (CZP;CIMZIA ((R)),联合制药,比利时布鲁塞尔)以前没有评价不错。目的:确定CZP的临床疗效和成本效益和SEC治疗活性PsA成年人谁DMARDs已经不足有效。设计:系统回顾和经济模型。数据来源:14个数据库(MEDLINE和EMBASE等)寻找相关的研究从开始到2016年4月CZP与证交会研究;必威国际app更新搜索运行识必威国际app别新的比较研究。 REVIEW METHODS: Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis (NMA) methods to investigate the relative efficacy of SEC and CZP compared with comparator therapies. A de novo model was developed to assess the cost-effectiveness of SEC and CZP compared with the other relevant comparators. The model was specified for three subpopulations, in accordance with the NICE scope (patients who have taken one prior DMARD, patients who have taken two or more prior DMARDs and biologic-experienced patients). The models were further classified according to the level of concomitant psoriasis. RESULTS: Nineteen eligible RCTs were included in the systematic review of short-term efficacy. Most studies were well conducted and were rated as being at low risk of bias. Trials of SEC and CZP demonstrated clinically important efficacy in all key clinical outcomes. At 3 months, patients taking 150 mg of SEC [relative risk (RR) 6.27, 95% confidence interval (CI) 2.55 to 15.43] or CZP (RR 3.29, 95% CI 1.94 to 5.56) were more likely to be responders than patients taking placebo. The NMA results for the biologic-naive subpopulations indicated that the effectiveness of SEC and CZP relative to other biologics and each other was uncertain. Limited data were available for the biologic-experienced subpopulation. Longer-term evidence suggested that these newer biologics reduced disease progression, with the benefits being similar to those seen for older biologics. The de novo model generated incremental cost-effectiveness ratios (ICERs) for three subpopulations and three psoriasis subgroups. In subpopulation 1 (biologic-naive patients who had taken one prior DMARD), CZP was the optimal treatment in the moderate-severe psoriasis subgroup and 150 mg of SEC was optimal in the subgroups of patients with mild-moderate psoriasis or no concomitant psoriasis. In subpopulation 2 (biologic-naive patients who had taken two or more prior DMARDs), etanercept (ETN; ENBREL((R)), Pfizer Inc., New York City, NY, USA) is likely to be the optimal treatment in all subgroups. The ICERs for SEC and CZP versus best supportive care are in the region of pound20,000-30,000 per quality-adjusted life-year (QALY). In subpopulation 3 (biologic-experienced patients or patients in whom biologics are contraindicated), UST is likely to be the optimal treatment (ICERs are in the region of pound21,000-27,000 per QALY). The optimal treatment in subpopulation 2 was sensitive to the choice of evidence synthesis model. In subpopulations 2 and 3, results were sensitive to the algorithm for Health Assessment Questionnaire-Disability Index costs. The optimal treatment is not sensitive to the use of biosimilar prices for ETN and infliximab (REMICADE((R)), Merck Sharp & Dohme, Kenilworth, NJ, USA). CONCLUSIONS: SEC and CZP may be an effective use of NHS resources, depending on the subpopulation and subgroup of psoriasis severity. There are a number of limitations to this assessment, driven mainly by data availability. FUTURE WORK: Trials are needed to inform effectiveness of biologics in biologic-experienced populations. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016033357. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

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药物

Certolizumab pegol

药物靶点

药物	目标	类	生物	药理作用	行动
Certolizumab pegol	肿瘤坏死因子	蛋白质	人类	是的	中和剂	细节