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Search result flow diagram
Figuras y tablas -
Figure 1

Search result flow diagram

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Assessment of publication bias
Figuras y tablas -
Figure 4

Assessment of publication bias

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 1 ACR 20% improvement.
Figuras y tablas -
Analysis 1.1

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 1 ACR 20% improvement.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 2 ACR 50% improvement.
Figuras y tablas -
Analysis 1.2

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 2 ACR 50% improvement.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 3 ACR 70% improvement.
Figuras y tablas -
Analysis 1.3

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 3 ACR 70% improvement.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 4 Improvement in physical function (HAQ: >0.22 or >0.3 increase from baseline, 0‐3 scale).
Figuras y tablas -
Analysis 1.4

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 4 Improvement in physical function (HAQ: >0.22 or >0.3 increase from baseline, 0‐3 scale).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 5 Achievement of low disease activity state (DAS 28<3.2, scale 0‐10).
Figuras y tablas -
Analysis 1.5

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 5 Achievement of low disease activity state (DAS 28<3.2, scale 0‐10).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 6 Achievement of remission (DAS 28 <2.6, scale 0‐10).
Figuras y tablas -
Analysis 1.6

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 6 Achievement of remission (DAS 28 <2.6, scale 0‐10).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 7 DAS‐28 ESR.
Figuras y tablas -
Analysis 1.7

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 7 DAS‐28 ESR.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 8 SF‐36 physical component score ‐ % same.
Figuras y tablas -
Analysis 1.8

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 8 SF‐36 physical component score ‐ % same.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 9 SF‐36 physical component score ‐ % better.
Figuras y tablas -
Analysis 1.9

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 9 SF‐36 physical component score ‐ % better.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 10 SF‐36 physical component score ‐ % worse.
Figuras y tablas -
Analysis 1.10

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 10 SF‐36 physical component score ‐ % worse.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 11 SF‐36 mental component score ‐ % same.
Figuras y tablas -
Analysis 1.11

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 11 SF‐36 mental component score ‐ % same.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 12 SF‐36 mental component score ‐ % better.
Figuras y tablas -
Analysis 1.12

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 12 SF‐36 mental component score ‐ % better.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 13 SF‐36 mental component score ‐ % worse.
Figuras y tablas -
Analysis 1.13

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 13 SF‐36 mental component score ‐ % worse.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 14 SF‐36 mental component score.
Figuras y tablas -
Analysis 1.14

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 14 SF‐36 mental component score.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 15 SF‐36 physical component score.
Figuras y tablas -
Analysis 1.15

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 15 SF‐36 physical component score.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 16 No. achieving population norm SF‐36 physical component score ‐ 6 months.
Figuras y tablas -
Analysis 1.16

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 16 No. achieving population norm SF‐36 physical component score ‐ 6 months.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 17 Patient reported pain (100 mm VAS).
Figuras y tablas -
Analysis 1.17

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 17 Patient reported pain (100 mm VAS).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 18 Patient global assessment.
Figuras y tablas -
Analysis 1.18

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 18 Patient global assessment.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 19 Physician global assessment.
Figuras y tablas -
Analysis 1.19

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 19 Physician global assessment.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 20 Physical function (HAQ‐DI & MHAQ).
Figuras y tablas -
Analysis 1.20

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 20 Physical function (HAQ‐DI & MHAQ).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 21 Tender joint count.
Figuras y tablas -
Analysis 1.21

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 21 Tender joint count.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 22 Swollen joint count.
Figuras y tablas -
Analysis 1.22

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 22 Swollen joint count.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 23 Radiographic progression (maximum erosion score 145).
Figuras y tablas -
Analysis 1.23

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 23 Radiographic progression (maximum erosion score 145).

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 24 Withdrawals due to adverse events.
Figuras y tablas -
Analysis 1.24

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 24 Withdrawals due to adverse events.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 25 All withdrawals.
Figuras y tablas -
Analysis 1.25

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 25 All withdrawals.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 26 Serious infections.
Figuras y tablas -
Analysis 1.26

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 26 Serious infections.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 27 Upper respiratory infections.
Figuras y tablas -
Analysis 1.27

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 27 Upper respiratory infections.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 28 Total adverse events.
Figuras y tablas -
Analysis 1.28

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 28 Total adverse events.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 29 Total serious adverse events.
Figuras y tablas -
Analysis 1.29

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 29 Total serious adverse events.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 30 Death.
Figuras y tablas -
Analysis 1.30

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 30 Death.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 31 Malignancies.
Figuras y tablas -
Analysis 1.31

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 31 Malignancies.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 32 Cough.
Figuras y tablas -
Analysis 1.32

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 32 Cough.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 33 Nausea.
Figuras y tablas -
Analysis 1.33

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 33 Nausea.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 34 Headache.
Figuras y tablas -
Analysis 1.34

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 34 Headache.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 35 Dizziness.
Figuras y tablas -
Analysis 1.35

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 35 Dizziness.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 36 Diarrhea.
Figuras y tablas -
Analysis 1.36

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 36 Diarrhea.

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Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 37 Infusion reaction (within 24 hours after infusion).
Figuras y tablas -
Analysis 1.37

Comparison 1 Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic, Outcome 37 Infusion reaction (within 24 hours after infusion).

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 1 ACR 20% improvement.
Figuras y tablas -
Analysis 2.1

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 1 ACR 20% improvement.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 2 ACR 50% improvement.
Figuras y tablas -
Analysis 2.2

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 2 ACR 50% improvement.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 3 ACR 70% improvement.
Figuras y tablas -
Analysis 2.3

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 3 ACR 70% improvement.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 4 Physical function (mHAQ, 0‐3 scale).
Figuras y tablas -
Analysis 2.4

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 4 Physical function (mHAQ, 0‐3 scale).

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 5 Patient assessment of pain (100 mm VAS).
Figuras y tablas -
Analysis 2.5

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 5 Patient assessment of pain (100 mm VAS).

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 6 Withdrawals due to adverse events ‐ 12 months.
Figuras y tablas -
Analysis 2.6

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 6 Withdrawals due to adverse events ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 7 All withdrawals ‐ 12 months.
Figuras y tablas -
Analysis 2.7

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 7 All withdrawals ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 8 Serious infections ‐ 12 months.
Figuras y tablas -
Analysis 2.8

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 8 Serious infections ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 9 Upper respiratory infections ‐ 12 months.
Figuras y tablas -
Analysis 2.9

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 9 Upper respiratory infections ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 10 Total adverse events ‐ 12 months.
Figuras y tablas -
Analysis 2.10

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 10 Total adverse events ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 11 Total serious adverse events ‐ 12 months.
Figuras y tablas -
Analysis 2.11

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 11 Total serious adverse events ‐ 12 months.

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Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 12 Death ‐ 12 months.
Figuras y tablas -
Analysis 2.12

Comparison 2 Abatacept (2 mg/kg) + etanercept versus placebo + etanercept, Outcome 12 Death ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 1 Withdrawals due to adverse events ‐ 12 months.
Figuras y tablas -
Analysis 3.1

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 1 Withdrawals due to adverse events ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 2 All withdrawals ‐ 12 months.
Figuras y tablas -
Analysis 3.2

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 2 All withdrawals ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 3 Serious infections ‐ 12 months.
Figuras y tablas -
Analysis 3.3

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 3 Serious infections ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 4 Upper respiratory infections ‐ 12 months.
Figuras y tablas -
Analysis 3.4

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 4 Upper respiratory infections ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 5 Total adverse events ‐ 12 months.
Figuras y tablas -
Analysis 3.5

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 5 Total adverse events ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 6 Total serious adverse events ‐ 12 months.
Figuras y tablas -
Analysis 3.6

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 6 Total serious adverse events ‐ 12 months.

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Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 7 Death ‐ 12 months.
Figuras y tablas -
Analysis 3.7

Comparison 3 Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic, Outcome 7 Death ‐ 12 months.

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Comparison 4 Abatacept versus placebo (by dosage), Outcome 1 ACR 20% improvement.
Figuras y tablas -
Analysis 4.1

Comparison 4 Abatacept versus placebo (by dosage), Outcome 1 ACR 20% improvement.

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Comparison 4 Abatacept versus placebo (by dosage), Outcome 2 ACR 50% improvement.
Figuras y tablas -
Analysis 4.2

Comparison 4 Abatacept versus placebo (by dosage), Outcome 2 ACR 50% improvement.

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Comparison 4 Abatacept versus placebo (by dosage), Outcome 3 ACR 70% improvement.
Figuras y tablas -
Analysis 4.3

Comparison 4 Abatacept versus placebo (by dosage), Outcome 3 ACR 70% improvement.

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Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 1 ACR 20% improvement.
Figuras y tablas -
Analysis 5.1

Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 1 ACR 20% improvement.

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Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 2 ACR 50% improvement.
Figuras y tablas -
Analysis 5.2

Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 2 ACR 50% improvement.

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Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 3 ACR 70% improvement.
Figuras y tablas -
Analysis 5.3

Comparison 5 Abatacept versus placebo (by study eligibility criteria), Outcome 3 ACR 70% improvement.

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Comparison 6 Abatacept versus placebo (funnel plot), Outcome 1 ACR 20% improvement ‐ 6 months.
Figuras y tablas -
Analysis 6.1

Comparison 6 Abatacept versus placebo (funnel plot), Outcome 1 ACR 20% improvement ‐ 6 months.

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Comparison 6 Abatacept versus placebo (funnel plot), Outcome 2 ACR 50% improvement ‐ 6 months.
Figuras y tablas -
Analysis 6.2

Comparison 6 Abatacept versus placebo (funnel plot), Outcome 2 ACR 50% improvement ‐ 6 months.

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Comparison 6 Abatacept versus placebo (funnel plot), Outcome 3 ACR 50% ‐ 1 year.
Figuras y tablas -
Analysis 6.3

Comparison 6 Abatacept versus placebo (funnel plot), Outcome 3 ACR 50% ‐ 1 year.

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Summary of findings for the main comparison. Abatacept (2 and 10mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic for rheumatoid arthritis

Abatacept (2 and 10mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic for rheumatoid arthritis

Patient or population: patients with rheumatoid arthritis
Settings:
Intervention: Abatacept (2 and 10mg/kg) + DMARDs/biologic
Comparison: Placebo + DMARDs/biologic

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo + DMARDs/biologic

Abatacept (2 and 10mg/kg) + DMARDs/biologic

ACR 50% improvement
Follow‐up: 12 months

RR 2.21
(1.73 to 2.82)

993
(3 studies)

⊕⊕⊕⊝
moderate1,2,3

Absolute risk difference= 21% (16% to 27%). Relative percent change=121% (73% to 182%). NNT=5 (4 to 7)4

168 per 1000

371 per 1000
(291 to 474)

Pain
measured at end of study on a 100 mm visual analog scale. Scale from: 0 (better) to 100 (worse).
Follow‐up: 12 months

The mean pain in the control groups was
49.24 mm

The mean pain in the intervention groups was
10.71 lower
(12.97 to 8.45 lower)

1425
(1 study5)

⊕⊕⊕⊝
moderate2

Absolute risk difference=‐11% (‐13% to ‐8.5%). Relative percent change=‐18% (‐22% to ‐14%). NNT=5 (4 to 6)4

Improvement in physical function (HAQ: greater than 0.3 increase from baseline, 0‐3 scale)
Follow‐up: 12 months

RR 1.62
(1.35 to 1.95)

638
(1 study6)

⊕⊕⊕⊝
moderate1

Absolute risk difference= 24% (16% to 32%). Relative percent change= 62% (35% to 95%). NNT=5 (4 to 7)4

393 per 1000

637 per 1000
(531 to 766)

Achievement of low disease activity state (DAS 28 less than 3.2, scale 0‐10)
Follow‐up: 12 months

RR 4.33
(2.84 to 6.59)

638
(1 study6)

⊕⊕⊕⊝
moderate1

Absolute risk difference=33% (26% to 39%). Relative percent change=333% (184% to 559%). NNT=4 (3 to 5)4

98 per 1000

424 per 1000
(278 to 646)

Total serious adverse events
Follow‐up: 6 to 12 months

RR 1.05
(0.87 to 1.28)

3151
(6 studies)

⊕⊕⊕⊝
moderate1,2,3,7

Absolute risk difference=1% (‐2% to 3%). Relative percent change=5% (‐14% to 29%). NNT=n/a4

121 per 1000

127 per 1000
(105 to 155)

Change in radiographic progression
measured by Genant‐modifed Sharp erosion score (increase in score means more joint damage). Scale from: 0 to 145.
Follow‐up: 12 months

The median change in radiographic progression in the control group was
0.27 units

The median change in radiographic progression in the intervention group was
0 units

586
(1 study6)

⊕⊕⊕⊝
moderate1,8

Note there was no change in the abatacept group. MD ‐0.27 (‐0.42, ‐0.12). Absolute RD=‐0.2% (‐0.3% to ‐0.08%). Relative percent change=‐1.2% (‐1.9% to ‐0.6%). 9

Long‐term serious adverse events
Follow‐up: 2 years

See comment

See comment

Not estimable

950
(2 studies11)

⊕⊕⊝⊝
low10

Number of patients with SAE: Genovese 2005: 103/357; 23.4 SAE/100 patient‐years; 70% completed the LTE. Kremer 2006: 149/593; 16.3 SAE/100 patient‐years; 90.5% completed the LTE.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Kremer 2006: Intention to treat analysis not performed. 9 patients in abatacept group and 5 in placebo group excluded from analysis.
2 Weinblatt 2006: 15 people randomized were not treated and not included in analysis
3 Kremer 2003: Risk of attrition bias ‐ less than 80% completion rate in treatment group at 12 months
4 NOTE: Number needed to treat (NNT)=n/a when result is not statistically significant. NNT for dichotomous outcomes calculated using Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office).
5 Outcome based on Weinblatt 2006
6 Outcome based on Kremer 2006
7 Weinblatt 2007: Risk of attrition bias ‐ less than 80% completion rate in the treatment group at 12 months
8 Radiographic data obtained for 90% of study participants
9 RD=risk difference
10 Long‐term serious adverse events based on observational data. Two RCTs had a long‐term extension (LTE) phase in which people in the placebo group during the RCT switched to abatacept for the LTE.
11 Based on 2 long‐term extension studies (LTE) of RCTs. Participants on placebo in the RCT switched to abatacept treatment.

Figuras y tablas -
Summary of findings for the main comparison. Abatacept (2 and 10mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic for rheumatoid arthritis
Ir a la tabla de la revisión
Table 1. Patient ‐reported pain results

Study ID

Pain scale

Baseline mean

End of study mean

% improvement, mean

Mean change from baseline

Variance (P value or CI)

Moreland 2002 ‐ abatacept; 85 days

1‐5

3.47

2.43

28.1

‐

NR

Moreland 2002 ‐ placebo; 85 days

1‐5

3.55

3.24

4.6

‐

NR

Kremer 2003 ‐ abatacept; 6 months

100mm VAS

NR

NR

‐

‐46.4

P < 0.05 (between groups)

Kremer 2003 ‐ placebo; 6 months

100mm VAS

NR

NR

‐

‐8.4

‐

Weinblatt 2006 ‐ abatacept; 1 yr

VAS

NR

NR

‐

‐26.3

P < 0.001 (within group)

Weinblatt 2006 ‐ placebo; 1 yr

VAS

NR

NR

‐

‐16.4

P < 0.001 (within group)

Weinblatt 2007 ‐ abatacept; 1 yr

NR

65.5

43.6

33.4

‐22.0

P < 0.001 (within group)

Weinblatt 2007 ‐ placebo; 1 yr

NR

53.2

47.4

10.9

‐7.1

P < 0.001 (within group)

Kremer 2006 ‐ abatacept; 1 yr

100mm VAS

NR

NR

‐

‐35.8

‐12.6 95% CI (‐16.9 to ‐8.39)

Kremer 2006 ‐ placebo; 1 yr

100mm VAS

NR

NR

‐

‐23.2

NR = not reported

VAS = visual analogue scale

*calculated as the average of the changes in the individual patient data
Figuras y tablas -
Table 1. Patient ‐reported pain results
Ir a la tabla de la revisión
Comparison 1. Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 ACR 20% improvement Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

1.7 [0.93, 3.12]

1.2 6 months

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.59, 2.02]

1.3 12 months

3

993

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.55, 2.07]

2 ACR 50% improvement Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

2.5 [0.52, 11.96]

2.2 6 months

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [2.00, 3.07]

2.3 12 months

3

993

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [1.73, 2.82]

3 ACR 70% improvement Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.25, 100.20]

3.2 6 months

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

3.53 [2.41, 5.16]

3.3 12 months

3

993

Risk Ratio (M‐H, Fixed, 95% CI)

4.02 [2.62, 6.18]

4 Improvement in physical function (HAQ: >0.22 or >0.3 increase from baseline, 0‐3 scale) Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months (>0.22)

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.73 [1.29, 2.33]

4.2 6 months (>0.3)

2

655

Risk Ratio (M‐H, Fixed, 95% CI)

1.73 [1.41, 2.13]

4.3 12 months (0.22)

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.27, 2.52]

4.4 12 months (>0.3)

1

638

Risk Ratio (M‐H, Fixed, 95% CI)

1.62 [1.35, 1.95]

5 Achievement of low disease activity state (DAS 28<3.2, scale 0‐10) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

1027

Risk Ratio (M‐H, Fixed, 95% CI)

3.36 [2.28, 4.96]

5.2 12 months

1

638

Risk Ratio (M‐H, Fixed, 95% CI)

4.33 [2.84, 6.59]

6 Achievement of remission (DAS 28 <2.6, scale 0‐10) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 6 months

2

1027

Risk Ratio (M‐H, Random, 95% CI)

2.50 [0.57, 11.03]

6.2 12 months

1

638

Risk Ratio (M‐H, Random, 95% CI)

12.74 [4.76, 34.15]

7 DAS‐28 ESR Show forest plot

1

266

Mean Difference (IV, Fixed, 95% CI)

‐0.95 [‐1.20, ‐0.70]

8 SF‐36 physical component score ‐ % same Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.56, 0.78]

8.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.61, 0.88]

8.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.41, 0.75]

9 SF‐36 physical component score ‐ % better Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

1.90 [1.52, 2.39]

9.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

1.93 [1.38, 2.70]

9.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.88 [1.39, 2.54]

10 SF‐36 physical component score ‐ % worse Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.44, 1.14]

10.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.41, 1.27]

10.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.29, 1.63]

11 SF‐36 mental component score ‐ % same Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.73, 1.03]

11.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.71, 1.14]

11.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.64, 1.05]

12 SF‐36 mental component score ‐ % better Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [1.15, 1.76]

12.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [1.03, 1.83]

12.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.50 [1.08, 2.07]

13 SF‐36 mental component score ‐ % worse Show forest plot

2

623

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.44, 0.94]

13.1 6 months

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.48, 1.09]

13.2 12 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.15, 1.08]

14 SF‐36 mental component score Show forest plot

3

1293

Mean Difference (IV, Fixed, 95% CI)

2.72 [1.57, 3.87]

15 SF‐36 physical component score Show forest plot

3

1293

Mean Difference (IV, Fixed, 95% CI)

4.29 [3.22, 5.35]

16 No. achieving population norm SF‐36 physical component score ‐ 6 months Show forest plot

1

389

Risk Ratio (M‐H, Fixed, 95% CI)

2.36 [1.34, 4.14]

17 Patient reported pain (100 mm VAS) Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 12 months

3

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Patient global assessment Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Totals not selected

18.1 6 months

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

18.2 12 months

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

19 Physician global assessment Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

19.1 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

19.2 12 months

3

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Physical function (HAQ‐DI & MHAQ) Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

20.1 6 months

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.2 12 months

3

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Tender joint count Show forest plot

2

1011

Mean Difference (IV, Fixed, 95% CI)

‐7.30 [‐8.79, ‐5.80]

21.1 6 months

1

232

Mean Difference (IV, Fixed, 95% CI)

‐7.36 [‐10.58, ‐4.14]

21.2 12 months

2

779

Mean Difference (IV, Fixed, 95% CI)

‐7.28 [‐8.97, ‐5.59]

22 Swollen joint count Show forest plot

2

1011

Mean Difference (IV, Fixed, 95% CI)

‐4.81 [‐5.79, ‐3.83]

22.1 6 months

1

232

Mean Difference (IV, Fixed, 95% CI)

‐4.93 [‐7.14, ‐2.72]

22.2 12 months

2

779

Mean Difference (IV, Fixed, 95% CI)

‐4.78 [‐5.87, ‐3.68]

23 Radiographic progression (maximum erosion score 145) Show forest plot

1

586

Mean Difference (IV, Fixed, 95% CI)

‐0.27 [‐0.42, ‐0.12]

24 Withdrawals due to adverse events Show forest plot

6

3105

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.30 [0.91, 1.85]

24.1 6 months

2

657

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.11 [0.42, 2.96]

24.2 12 months

4

2448

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.33 [0.90, 1.95]

25 All withdrawals Show forest plot

7

3169

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.52, 0.70]

25.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.12, 0.92]

25.2 6 months

2

657

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.44, 0.96]

25.3 12 months

4

2448

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.51, 0.72]

26 Serious infections Show forest plot

5

2871

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.56 [0.93, 2.61]

26.1 6 months

2

657

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.76 [0.25, 2.28]

26.2 12 months

3

2214

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.91 [1.07, 3.42]

27 Upper respiratory infections Show forest plot

5

2839

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.22 [0.84, 1.76]

27.1 6 months

1

391

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.75 [0.32, 1.77]

27.2 12 months

4

2448

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.36 [0.90, 2.04]

28 Total adverse events Show forest plot

5

2871

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [1.01, 1.08]

28.1 6 months

2

657

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.97, 1.15]

28.2 12 months

3

2214

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [1.01, 1.08]

29 Total serious adverse events Show forest plot

6

3151

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.86, 1.29]

29.1 6 months

2

703

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.49, 1.31]

29.2 12 months

4

2448

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.89, 1.39]

30 Death Show forest plot

6

3105

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.82 [0.26, 2.60]

30.1 6 months

2

657

Peto Odds Ratio (Peto, Fixed, 95% CI)

5.02 [0.29, 88.42]

30.2 12 months

4

2448

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.58 [0.17, 2.04]

31 Malignancies Show forest plot

5

2710

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.00 [0.59, 1.71]

31.1 6 months

1

266

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.70 [0.04, 11.72]

31.2 12 months

4

2444

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.02 [0.59, 1.75]

32 Cough Show forest plot

3

1241

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.80, 1.70]

32.1 6 months

1

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.56, 2.76]

32.2 12 months

3

1007

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.74, 1.75]

33 Nausea Show forest plot

5

1696

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.89, 1.58]

33.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

2.5 [0.52, 11.96]

33.2 6 months

2

625

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.65, 1.80]

33.3 12 months

3

1007

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.82, 1.69]

34 Headache Show forest plot

6

3137

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [1.20, 1.74]

34.1 3 months

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

8.0 [1.06, 60.32]

34.2 6 months

2

625

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [0.85, 2.38]

34.3 12 months

4

2448

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [1.15, 1.72]

35 Dizziness Show forest plot

3

1164

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [0.92, 2.53]

35.1 6 months

1

391

Risk Ratio (M‐H, Fixed, 95% CI)

4.66 [0.25, 85.84]

35.2 12 months

2

773

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.86, 2.41]

36 Diarrhea Show forest plot

4

1632

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.94, 1.85]

36.1 6 months

2

625

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.71, 2.49]

36.2 12 months

3

1007

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.88, 1.96]

37 Infusion reaction (within 24 hours after infusion) Show forest plot

4

2750

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [1.13, 1.50]

37.1 6 months

2

657

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.44, 1.64]

37.2 12 months

2

2093

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [1.16, 1.55]
Figuras y tablas -
Comparison 1. Abatacept (2 mg/kg and 10 mg/kg) + DMARDs/biologic versus placebo + DMARDs/biologic
Ir a la tabla de la revisión
Comparison 2. Abatacept (2 mg/kg) + etanercept versus placebo + etanercept

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 ACR 20% improvement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [0.92, 2.71]

1.2 12 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [0.92, 2.71]

2 ACR 50% improvement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.63, 2.83]

2.2 12 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [0.76, 3.79]

3 ACR 70% improvement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

8.17 [0.49, 136.81]

3.2 12 months

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [0.38, 7.59]

4 Physical function (mHAQ, 0‐3 scale) Show forest plot

1

121

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.27, 0.07]

5 Patient assessment of pain (100 mm VAS) Show forest plot

1

121

Mean Difference (IV, Fixed, 95% CI)

‐3.40 [‐14.86, 8.06]

6 Withdrawals due to adverse events ‐ 12 months Show forest plot

1

121

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.94 [0.76, 11.34]

7 All withdrawals ‐ 12 months Show forest plot

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.49, 1.37]

8 Serious infections ‐ 12 months Show forest plot

1

121

Peto Odds Ratio (Peto, Fixed, 95% CI)

4.25 [0.35, 51.61]

9 Upper respiratory infections ‐ 12 months Show forest plot

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [0.69, 4.16]

10 Total adverse events ‐ 12 months Show forest plot

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.92, 1.19]

11 Total serious adverse events ‐ 12 months Show forest plot

1

121

Peto Odds Ratio (Peto, Fixed, 95% CI)

3.49 [1.08, 11.34]

12 Death ‐ 12 months Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 2. Abatacept (2 mg/kg) + etanercept versus placebo + etanercept
Ir a la tabla de la revisión
Comparison 3. Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Withdrawals due to adverse events ‐ 12 months Show forest plot

2

288

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.68 [1.07, 6.72]

2 All withdrawals ‐ 12 months Show forest plot

2

706

Risk Ratio (M‐H, Random, 95% CI)

0.16 [0.00, 37.14]

3 Serious infections ‐ 12 months Show forest plot

2

288

Peto Odds Ratio (Peto, Fixed, 95% CI)

3.20 [0.86, 11.97]

4 Upper respiratory infections ‐ 12 months Show forest plot

2

288

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.79 [0.75, 4.26]

5 Total adverse events ‐ 12 months Show forest plot

2

288

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.98, 1.14]

6 Total serious adverse events ‐ 12 months Show forest plot

2

288

Risk Ratio (M‐H, Fixed, 95% CI)

2.30 [1.15, 4.62]

7 Death ‐ 12 months Show forest plot

2

288

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 3. Abatacept (2 mg/kg and 10 mg/kg) + biologic versus placebo + biologic
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Comparison 4. Abatacept versus placebo (by dosage)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 ACR 20% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months ‐ 2 mg/kg

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [0.92, 2.71]

1.2 6 months ‐ 10 mg/kg

4

1527

Risk Ratio (M‐H, Fixed, 95% CI)

1.81 [1.60, 2.04]

1.3 6 months ‐ combined dosage

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.59, 2.02]

2 ACR 50% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months ‐ 2 mg/kg

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.63, 2.83]

2.2 6 months ‐ 10 mg/kg

4

1527

Risk Ratio (M‐H, Fixed, 95% CI)

2.59 [2.07, 3.25]

2.3 6 months ‐ combined dosage

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [2.00, 3.07]

3 ACR 70% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months ‐ 2 mg/kg

1

121

Risk Ratio (M‐H, Fixed, 95% CI)

8.17 [0.49, 136.81]

3.2 6 months ‐ 10 mg/kg

4

1527

Risk Ratio (M‐H, Fixed, 95% CI)

3.43 [2.34, 5.04]

3.3 6 months ‐ combined dosage

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

3.53 [2.41, 5.16]
Figuras y tablas -
Comparison 4. Abatacept versus placebo (by dosage)
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Comparison 5. Abatacept versus placebo (by study eligibility criteria)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 ACR 20% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 MTX failures

3

1138

Risk Ratio (M‐H, Fixed, 95% CI)

1.68 [1.48, 1.91]

1.2 Biologic failures

2

510

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [1.67, 3.07]

2 ACR 50% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 MTX failures

3

1138

Risk Ratio (M‐H, Fixed, 95% CI)

2.38 [1.89, 3.00]

2.2 Biologic failures

2

510

Risk Ratio (M‐H, Fixed, 95% CI)

2.96 [1.67, 5.25]

3 ACR 70% improvement Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 MTX failures

3

1138

Risk Ratio (M‐H, Fixed, 95% CI)

3.16 [2.12, 4.71]

3.2 Biologic failures

2

510

Risk Ratio (M‐H, Fixed, 95% CI)

7.05 [1.98, 25.14]
Figuras y tablas -
Comparison 5. Abatacept versus placebo (by study eligibility criteria)
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Comparison 6. Abatacept versus placebo (funnel plot)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 ACR 20% improvement ‐ 6 months Show forest plot

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.59, 2.02]

1.1 6 months ‐ for funnel plot

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.59, 2.02]

2 ACR 50% improvement ‐ 6 months Show forest plot

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [2.00, 3.07]

2.1 6 months

5

1648

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [2.00, 3.07]

3 ACR 50% ‐ 1 year Show forest plot

3

993

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [1.73, 2.82]

3.1 12 months

3

993

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [1.73, 2.82]
Figuras y tablas -
Comparison 6. Abatacept versus placebo (funnel plot)
Ir a la tabla de la revisión