Indirect comparison of etanercept, infliximab, and adalimumab for psoriatic arthritis: mixed treatment comparison using placebo as common comparator

Psoriatic arthritis (PsA) is a chronic inflammatory joint disorder that is commonly associated with skin psoriatic lesions and can lead to severe disability. Current pharmacologic therapy for PsA includes TNFα-blocking agents for patients who are intolerant of or have an inadequate response to conventional disease-modifying antirheumatic drugs. Currently, there are no published randomized controlled trials providing a head-to-head comparison of the effectiveness of the three TNFα-blocking agents used most often to treat patients with PsA (adalimumab, etanercept, and infliximab). In this study, we have performed the first indirect comparison among these biologic agents, in this setting, using a mixed treatment comparison analysis of the data from pivotal trials regarding efficacy profiles of adalimumab, etanercept, and infliximab evaluated as American College of Rheumatology (ACR) 20 response. Our results suggest that etanercept is expected to provide the greatest ACR20 response among the anti-TNFα agents compared with placebo in the treatment of patients with PsA unresponsive to conventional treatments. This analysis may be relevant for clinical decision-making, hence improving the management of PsA patients.