A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis.
A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis.
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类风湿关节炎早期介入治疗安全性的系统回顾和网络荟萃分析。
DOI：
10.1093/rheumatology/keab429
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发表时间：
2021-10-02
期刊：
影响因子：
--
通讯作者：
Galloway JB
中科院分区：
文献类型：
--
作者：
Adas MA;Allen VB;Yates M;Bechman K;Clarke BD;Russell MD;Rutherford AI;Cope AP;Norton S;Galloway JB
目的：评价早期类风湿关节炎(RA)患者治疗策略的安全性。对MEDLINE、EMBASE和PubMed进行系统检索，直至2020年9月。纳入了对完全幼稚或MTX-幼稚RA患者进行特许治疗的双盲随机对照试验(RCT)。长期推广研究、后继和汇集分析以及没有对照的随机对照试验被排除在外。从所有随机对照试验中提取严重不良事件、严重感染和非严重不良事件，并使用Meta分析和网络Meta分析(NMA)比较干预组和对照组的事件发生率。从最初的3423项研究中，纳入了20项研究，涉及9202名患者。Meta分析显示，严重不良事件、严重感染和非严重不良事件的年总发生率分别为69.8(95%CI：64.9、74.8)、18.9(95%CI：16.2、21.6)和1048.2(95%CI：1027.5、1068.9)。NMA显示生物单药治疗的严重不良事件发生率高于甲氨蝶呤单药治疗，发生率比1.39(95%CI：1.12，1.73)。生物单药治疗率高于甲氨蝶呤和类固醇治疗，比率为3.22(95%CI：1.47，7.07)。生物单一治疗的不良事件发生率高于生物联合治疗，发生率比为1.26(95%CI：1.02，1.54)。NMA显示，在严重感染和非严重不良事件发生率方面，两种策略之间没有显著差异。这项研究揭示了不同早期RA治疗策略的不同风险特征。观察到的差异总体上很小，与已有的RA研究结果相反，以类固醇为基础的治疗方案并未显示出更大的危害性。
To evaluate the safety of treatment strategies in patients with early RA. Systematic searches of MEDLINE, EMBASE and PubMed were conducted up to September 2020. Double-blind randomized controlled trials (RCTs) of licensed treatments conducted on completely naïve or MTX-naïve RA patients were included. Long-term extension studies, post-hoc and pooled analyses and RCTs with no comparator arm were excluded. Serious adverse events, serious infections and non-serious adverse events were extracted from all RCTs, and event rates in intervention and comparator arms were compared using meta-analysis and network meta-analysis (NMA). From an initial search of 3423 studies, 20 were included, involving 9202 patients. From the meta-analysis, the pooled incidence rates per 1000 patient-years for serious adverse events were 69.8 (95% CI: 64.9, 74.8), serious infections 18.9 (95% CI: 16.2, 21.6) and non-serious adverse events 1048.2 (95% CI: 1027.5, 1068.9). NMA showed that serious adverse event rates were higher with biologic monotherapy than with MTX monotherapy, rate ratio 1.39 (95% CI: 1.12, 1.73). Biologic monotherapy rates were higher than those for MTX and steroid therapy, rate ratio 3.22 (95% CI: 1.47, 7.07). Biologic monotherapy had a higher adverse event rate than biologic combination therapy, rate ratio 1.26 (95% CI: 1.02, 1.54). NMA showed no significant difference between strategies with respect to serious infections and non-serious adverse events rates. The study revealed the different risk profiles for various early RA treatment strategies. Observed differences were overall small, and in contrast to the findings of established RA studies, steroid-based regimens did not emerge as more harmful.
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影响因子：
27.4
作者：
Emery P;Burmester GR;Bykerk VP;Combe BG;Furst DE;Barré E;Karyekar CS;Wong DA;Huizinga TW
通讯作者：
Huizinga TW
影响因子：
27.4
作者：
Kavanaugh A;Fleischmann RM;Emery P;Kupper H;Redden L;Guerette B;Santra S;Smolen JS
通讯作者：
Smolen JS
影响因子：
27.4
作者：
Atsumi T;Yamamoto K;Takeuchi T;Yamanaka H;Ishiguro N;Tanaka Y;Eguchi K;Watanabe A;Origasa H;Yasuda S;Yamanishi Y;Kita Y;Matsubara T;Iwamoto M;Shoji T;Okada T;van der Heijde D;Miyasaka N;Koike T
通讯作者：
Koike T
影响因子：
27.4
作者：
Emery, P.;Bingham, C. O., III;Weinblatt, M. E.
通讯作者：
Weinblatt, M. E.
影响因子：
5.5
作者：
Bechman, Katie;Oke, Anuoluwapo;Galloway, James B.
通讯作者：
Galloway, James B.