Tumour necrosis factor (TNF)-alpha receptor plays a major role in the pathogeneisis of rheumatoid arthrirtis (RA). Certolizumab pegol is a biological medication and a selective inhibitor of TNF-alpha. In this  cochrane review Ruiz Garcia V et al reported the significant improvement in the progression of RA. 

To evaluate the Certolizumab pegol (CZP) clinical advantages and harms among individuals with RA who have not responded well towards conventional disease-modifying anti-rheumatic drugs (DMARDs).

The ICTRP of WHO, CENTRAL, Web of Knowledge, clinicaltrials.gov, MEDLINE, Embase, and reference lists of articles were searched from 2014 to 26 September 2016.  

A total of 14 trials involved in the analysis. Twelve involved measures of benefit; investigators pooled 11 out of them. Further, 13 trials comprised data regarding harms. The range of  Certolizumab pegol dose and duration of follow-up ranged from subcutaneous 50 to 400 mg and 12 to 52 weeks, respectively. During Phase II trials, the comparator was the only placebo and during Phase III trials, the comparator was placebo in five and placebo plus MTX in seven trials. The 200 mg Certolizumab pegol, the approved dose presented clinically significant improvements at 24 weeks for the outcomes - American College of Rheumatology (ACR) 50% improvement; The Health Assessment Questionnaire (HAQ); Proportion of participants achieving remission (Disease Activity Score (DAS); Radiological changes; and Serious adverse events (SAEs). A clinical notable rise in all withdrawals in the placebo groups was seen due to the adverse events in the Certolizumab groups. The estimation of the quality of evidence to be high for ACR50, SAEs, withdrawals due to adverse events and  DAS remission, and moderate for radiological changes and HAQ. Due to inconsistency, the quality of evidence to be average for all withdrawals.  

The outcomes and conclusions did not change from the prior review. There is a moderate to high evidence from that Certolizumab pegol, alone or combination with Methotrexate is useful in the RA management. Adverse effects were more prevalent with active therapy. The study discovered clinically but not statistically meaningful risk of severe adverse effects.