The number of studies providing information on the SF36 MCS was too limited to allow network meta analysis. Nine studies reported fatigue as an outcome measure, but given differences Vorinostat purchase in the instruments used, Fatigue Assessment Scale, and Fatigue VAS a network meta analysis was not considered feasible. In Figure 2 the network of the 17 RCTs is presented where each line between nodes reflects the available direct comparisons. By means of network meta analysis a treatment effect of each intervention rela tive to another that is part of the same network can be obtained. Table 1 provides information on the study and patient characteristics of the 17 RCTs used for the network meta analysis. The mean age in the study arms ranged from 48 to 57. Female patients were predominant.

the proportion of women in the study arms ranged from 66% to 90%. Disease duration ranged from 4. 5 to 13 years, swollen joint count ranged from 11. 3 to 21. 9, and tender joint count ranged from 13 to 35. 5. The re ported ESR ranged from 25 to 56. 1 mm/1 hr, CRP varied between 8 and 52. 6, and rheumatoid factor positivity ranged from 77% to 100%. Despite some variation in patient characteristics across studies, there were no observed systematic differences across the different types of direct comparisons, indicating the feasibility of the network meta analysis. Monotherapy In Tables 2, 3, 4 and 5 the results of the network meta analysis are presented. Each cell presents the difference in change from baseline for the outcome of interest 24 weeks with the intervention relative to a comparator.

Individual study results are provided in Additional file 1 Table S1. Both aTNF and tocilizumab as monotherapy demonstrated greater reductions in pain, self reported disease activity, and HAQ DI scores than placebo. These improve ments over placebo were larger than the MCID for each endpoint. Tocilizumab monotherapy showed greater improve ments in pain than aTNF as monotherapy, and can be expected to be more efficacious in terms of PGA as well. Tocilizumab was at least as efficacious as aTNF agents in HAQ DI improvements. In Figure 3 the expected reduction in pain, PGA and HAQ DI for each treatment as monotherapy is presented. Given the available studies, no comparison of SF36 for the biologics as monotherapy was possible.

Treatment in combination with methotrexate aTNF, abatacept and toci lizumab in combination with MTX showed comparable reductions in pain and PGA relative to MTX in this DMARD IR population. These improvements over MTX are expected to be greater than Brefeldin_A the MCID. The reduction in pain and PGA with anakinra was smaller. Regarding HAQ DI, the greatest improvements over MTX can be expected with aTNF and tocilizumab, both clinically meaningful, followed by abatacept and anakinra. Improvements in physical health according to the SF36 PCS with abatacept, aTNF inhibitor licensed and tocilizumab were comparable.