Etanercept ( Enbrel ) has been widely applied in the treatment of ankylosing spondylitis ( AS ). Previous meta-analyses have focused on comparing the differences in clinical outcomes between Etanercept and placebo.
The present meta-analysis evaluated randomised controlled trials ( RCTs ) to compare the effects of Etanercept and placebo or Sulfasalazine in patients with ankylosing spondylitis.
The study population characteristics and the main results, including the Assessment in AS 20% response ( ASAS 20 ), the Bath AS Disease Activity Index ( BASDAI ) and the Bath AS Functional Index ( BASFI ), were extracted.
Fifteen randomised controlled trials involving 2,194 subjects were included.
Compared with a placebo, Etanercept significantly improved the ASAS 20 [ P less than 0.00001; odds ratio, OR=8.25; 95% confidence interval (CI), 5.92-11.50 ], BASDAI ( P less than 0.00001; MD, -18.81; 95% CI, -24.47 to -13.15 ) and BASFI ( P less than 0.00001; standard MD, -0.68; 95% CI, -0.85 to -0.50 ).
In comparison with Sulfasalazine, Etanercept significantly decreased the BASDAI ( P less than 0.00001; MD, -2.40; 95% CI, -2.89 to -1.90 ) and C-reactive protein ( CRP ) levels ( P less than 0.0001; MD, -8.01; 95% CI, -11.73 to -4.29 ).
The most common adverse effect of Etanercept was an injection site reaction.
This meta-analysis has shown that Etanercept monotherapy is effective in improving physical function and reducing disease activity in patients with ankylosing spondylitis.
Compared with Sulfasalazine, Etanercept markedly decreased the BASDAI and CRP levels.
However, the efficacy of Etanercept in treating AS requires further evaluation by more RCTs in a larger population of patients prior to recommending Etanercept as a substitute for synthetic disease-modifying antirheumatic drug ( DMARD ) monotherapy, or combinations of synthetic DMARDs. ( Xagena )
Liu YF, Exp Ther Med 2014;8:1585-1592