Are new drugs effective for treating Rheumatoid arthritis?

The challenge

Rheumatoid arthritis (RA) is an autoimmune condition that causes pain, swelling and stiffness in the joints. Through repeated swelling of the joint, ligaments may become stretched and slack, causing damage.

Disease modifying antirheumatic drugs (or DMARDs) inhibit this joint destruction. The drugs are not always effective, can lose effectiveness over time and can cause adverse side effects.

A new class of DMARDs is available, which includes so called TNF inhibitors Adalimumab, Etanercept and Infliximab. Evidence was needed to understand if these drugs are clinically and cost effective.


Arthritic hands

What we did

NIHR funded researchers undertook a systematic review of 29 trials on the effectiveness and cost-effectiveness of the drugs and reviewed industry submissions to the National Institute for Health and Clinical Excellence (NICE).

The Birmingham Rheumatoid Arthritis Model (BRAM), a simulation model, was further developed and used to produce an incremental cost-effectiveness analysis.



What we found

Adalimumab, etanercept and infliximab were all found to be effective treatments, compared with placebo, for RA patients who are not well controlled by conventional DMARDs, improving control of symptoms, physical function, and slowing changes in joints.

All things being equal, etanercept may be the TNF inhibitor of choice, although this may also depend on patient preference as to route of administration.




The study was used as evidence by the NICE Technology Appraisal Committee in their deliberations regarding the use of biologics in the treatment of rheumatoid arthritis. The report is cited as underpinning evidence in the NICE guidance on the use of TNF inhibitors in the  treatment of rheumatoid arthritis.

The technology has increased choice for patients, facilitated by the guidelines, which created access to these drugs and determined how they could be used.