[Background and Purpose]Rheumatoid arthritis (RA) is a chronic inflammatory disease that is an autoimmune disease. Now, guidelines from American College of Rheumatology (ACR), Japan College of Rheumatology (JCR) and European League Against Rheumatism (EULAR) recommend the combination therapy of methotrexate (MTX) with biologic Disease-Modifying Antirheumatic Drugs (bDMARDs)/ targeted synthetic DMARDs (tsDMARDs), of which several kinds are clinically available now, for the treatment of RA. We purposed to rank the efficacy and safety of bDMARDs/tsDMARDs through a Network Meta-Analysis (NMA).[Methods]Our study selected review reports from the Pharmaceuticals and Medical Devices Agency and studies from the database. We collected the data from studies in which the participants were RA patients, and the study design was randomized controlled trials. The experimental group was the combination therapy of MTX with bDMARDs/tsDMARDs, and the control group was MTX monotherapy or another combination therapy of MTX with bDMARDs/tsDMARDs. Efficacy outcomes were ACR20 and ACR50, and safety outcomes were the number of occurrences of Adverse Events, Serious Adverse Events, and infection. We compared the Surface Under the Cumulative Ranking Curves (SUCRA) score rankings of each outcome to find the best comprehensive treatment through cluster analysis.[Result and Discussion]From the comprehensive efficacy outcomes, the combination of Infliximab or Etanercept with MTX showed the highest efficacy. From the comprehensive safety outcomes, the combination of Etanercept with MTX showed the highest safety. Etanercept, which had a high ranking in terms of efficacy and safety, was an Fc fusion protein targeting TNF-α. These might be characteristics of high efficacy and safety in the treatment of RA.[Conclusion]According to the SUCRA ranking and cluster analysis obtained through NMA, it showed that Etanercept combined with MTX has relatively the highest efficacy and safety.
