Show simple item record

dc.contributor.authorTikhonova, Irina A.
dc.contributor.authorYang, Huiqin
dc.contributor.authorBello, Segun
dc.contributor.authorSalmon, Andrew
dc.contributor.authorRobinson, Sophie
dc.contributor.authorHemami, Mohsen Rezaei
dc.contributor.authorDodman, Sophie
dc.contributor.authorKharechko, Andriy
dc.contributor.authorHaigh, Richard C.
dc.contributor.authorJani, Meghna
dc.contributor.authorMcDonald, Timothy J.
dc.contributor.authorHoyle, Martin
dc.date.accessioned2021-10-01T12:21:23Z
dc.date.available2021-10-01T12:21:23Z
dc.date.issued2021-02-01
dc.identifier.citationTikhonova, I. A. et al. (2021) ‘Enzyme-linked immunosorbent assays for monitoring TNF-alpha inhibitors and antibody levels in people with rheumatoid arthritis: a systematic review and economic evaluation.’, Health technology assessment (Winchester, England), 25(8), pp. 1–248. doi: 10.3310/hta25080.
dc.identifier.pmid33555998
dc.identifier.doi10.3310/hta25080
dc.identifier.urihttps://rde.dspace-express.com/handle/11287/622053
dc.description.abstractBACKGROUND: Rheumatoid arthritis is a chronic autoimmune disease that primarily causes inflammation, pain and stiffness in the joints. People with severe disease may be treated with biological disease-modifying anti-rheumatic drugs, including tumour necrosis factor-α inhibitors, but the efficacy of these drugs is hampered by the presence of anti-drug antibodies. Monitoring the response to these treatments typically involves clinical assessment using response criteria, such as Disease Activity Score in 28 joints or European League Against Rheumatism. Enzyme-linked immunosorbent assays can also be used to measure drug and antibody levels in the blood. These tests may inform whether or not adjustments to treatment are required or help clinicians to understand the reasons for treatment non-response or a loss of response. METHODS: Systematic reviews were conducted to identify studies reporting on the clinical effectiveness and cost-effectiveness of using enzyme-linked immunosorbent assays to measure drug and anti-drug antibody levels to monitor the response to tumour necrosis factor-α inhibitors [adalimumab (Humira(®); AbbVie, Inc., North Chicago, IL, USA), etanercept (Enbrel(®); Pfizer, Inc., New York, NY, USA), infliximab (Remicade(®), Merck Sharp & Dohme Limited, Hoddesdon, UK), certolizumab pegol (Cimzia(®); UCB Pharma Limited, Slough, UK) and golimumab (Simponi(®); Merck Sharp & Dohme Limited)] in people with rheumatoid arthritis who had either achieved treatment target (remission or low disease activity) or shown primary or secondary non-response to treatment. A range of bibliographic databases, including MEDLINE, EMBASE and CENTRAL (Cochrane Central Register of Controlled Trials), were searched from inception to November 2018. The risk of bias was assessed using the Cochrane ROBINS-1 (Risk Of Bias In Non-randomised Studies - of Interventions) tool for non-randomised studies, with adaptations as appropriate. Threshold and cost-utility analyses that were based on a decision tree model were conducted to estimate the economic outcomes of adding therapeutic drug monitoring to standard care. The costs and resource use were considered from the perspective of the NHS and Personal Social Services. No discounting was applied to the costs and effects owing to the short-term time horizon of 18 months that was adopted in the economic analysis. The impact on the results of variations in testing and treatment strategies was explored in numerous clinically plausible sensitivity analyses. RESULTS: Two studies were identified: (1) a non-randomised controlled trial, INGEBIO, that compared standard care with therapeutic drug monitoring using Promonitor(®) assays [Progenika Biopharma SA (a Grifols-Progenika company), Derio, Spain] in Spanish patients receiving adalimumab who had achieved remission or low disease activity; and (2) a historical control study. The economic analyses were informed by INGEBIO. Different outcomes from INGEBIO produced inconsistent results in both threshold and cost-utility analyses. The cost-effectiveness of therapeutic drug monitoring varied, from the intervention being dominant to the incremental cost-effectiveness ratio of £164,009 per quality-adjusted life-year gained. However, when the frequency of testing was assumed to be once per year and the cost of phlebotomy appointments was excluded, therapeutic drug monitoring dominated standard care. LIMITATIONS: There is limited relevant research evidence and much uncertainty about the clinical effectiveness and cost-effectiveness of using enzyme-linked immunosorbent assay-based testing for therapeutic drug monitoring in rheumatoid arthritis patients. INGEBIO had serious limitations in relation to the National Institute for Health and Care Excellence scope: only one-third of participants had rheumatoid arthritis, the analyses were mostly not by intention to treat and the follow-up was 18 months only. Moreover, the outcomes might not be generalisable to the NHS. CONCLUSIONS: Based on the available evidence, no firm conclusions could be made about the cost-effectiveness of therapeutic drug monitoring in England and Wales. FUTURE WORK: Further controlled trials are required to assess the impact of using enzyme-linked immunosorbent assays for monitoring the anti-tumour necrosis factors in people with rheumatoid arthritis. STUDY REGISTRATION: This study is registered as PROSPERO CRD42018105195. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 8. See the NIHR Journals Library website for further project information.
dc.language.isoeng
dc.publisherNIHR
dc.relation.urlhttps://doi.org/10.3310/hta25080
dc.rights© NETSCC 2021
dc.rights.urihttp://creativecommons.org/publicdomain/zero/1.0/
dc.subjectADALIMUMAB
dc.subjectANTIBODIES
dc.subjectBIOLOGIC
dc.subjectBIOMARKER
dc.subjectCERTOLIZUMAB PEGOL
dc.subjectCOST-EFFECTIVENESS ANALYSIS
dc.subjectCOST-UTILITY ANALYSIS
dc.subjectDECISION TREE
dc.subjectDRUG MONITORING
dc.subjectENZYME-LINKED IMMUNOSORBENT ASSAY
dc.subjectETANERCEPT
dc.subjectGOLIMUMAB
dc.subjectINFLIXIMAB
dc.subjectRHEUMATOID ARTHRITIS
dc.subjectTUMOUR NECROSIS FACTOR-ALPHA
dc.titleEnzyme-linked immunosorbent assays for monitoring TNF-alpha inhibitors and antibody levels in people with rheumatoid arthritis: a systematic review and economic evaluation
dc.typesystematic review
dc.identifier.journalHealth technology assessment
dc.identifier.pmcidPMC7898084
dc.description.noteThis article is freely available online. Click on the 'Additional Link' above to access the full-text via the publisher's site.
dc.type.versionPublished
dc.description.admin-notePublished version, accepted version, submitted version


Files in this item

FilesSizeFormatView

There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record

© NETSCC 2021
Except where otherwise noted, this item's license is described as © NETSCC 2021