A head-to-head comparison of TNF-α inhibitors as the first biologic treatment of rheumatoid arthritis
Authors' conclusion
This hypothesis-generating study provides evidence that TNFis may not be equally effective.
Study context
- Population
- Adult bio-naïve rheumatoid arthritis (RA) patients in Norway starting a TNFi as their first biologic treatment (NOR-DMARD study)
- Exposure
- Head-to-head comparison of five TNFi as first biologic: infliximab vs certolizumab pegol vs etanercept vs golimumab vs adalimumab
- Outcome
- Remission
- Follow-up
- 3 months
Methodological detailstarget trial emulation, instrumental variable (drug cost) analysis, registry-based (NOR-DMARD), hypothesis-generating
- Target trial emulation
- Instrumental variable (drug cost) analysis
- Registry-based (NOR-DMARD)
- Hypothesis-generating
Main finding
As reported in the abstract
- Instrumental variable (IV) analysis: Infliximab (INX) showed higher remission rates vs certolizumab pegol (CZP)
- IV analysis: Etanercept (ETN) performed better than golimumab (GOM)
- CIs wide; many comparisons not statistically significant
Observational data: associations, not effects.
Further findings
Sensitivity analyses
- Confirmed the overall direction of results
Standard regression analysis adjusted for observed confounders · 3 months
- No substantial differences among TNFi
Original publication
A head-to-head comparison of TNF-α inhibitors as the first biologic treatment of rheumatoid arthritis. Rheumatology (Oxford). Published 14 January 2026. doi:10.
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