Objectives: To analyze available evidence on the efficacy of different biological response. Modifiers which are used for a treatment of rheumatoid arthritis. Methods: We searched systematically for randomized controlled clinical trials on treatment of rheumatoid arthritis with different biological response modifiers. Trials were searched from MEDLINE and Cochrane library database. Efficacy parameters ACR20, ACR50 ACR70 were analyzed for estimates combine Relative Risk (RR) and Number Need to Treat (NNT) using random effect model. Heterogeneity was evaluated by Cochrane’s Q and I2 statistics. Result: According to inclusion criteria, a total 42 trials (19,051) patients were included in this study. In general at ACR50 response etanercept (RR: 1.47, NNT: 1) is more efficacious as compared to other drugs. At recommended dose ACR20 response of adalimumab (RR: 2.42, NNT: 3) and at higher dose ACR 20 response of cetrolizumab (RR: 5.12, NNT: 2) most efficacious. At recommended dose level drugs is more efficacious if combine with methotrexate (ACR20 response, RR: 2.16, NNT: 3) as compared to methotrexate alone (RR: 1.38, NNT: 6) and placebo alone (RR: 2.61, NNT: 3).all the 42 trials provided evidence of significant heterogeneity with combine effect. Conclusion: Among the biological response modifiers anti-TNF inhibitors are highly effective and more efficacious if combine with methotrexate for treatment of rheumatoid arthritis and among them priority given to etanercept.