Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome
Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome
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DOI：
10.1093/rheumatology/keq195
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发表时间：
2010-11-01
期刊：
影响因子：
5.5
通讯作者：
Fransen, Jaap
中科院分区：
文献类型：
--
作者：
Schipper, Lydia G.;van Hulst, Laura T. C.;Fransen, Jaap
方法。我们进行了系统的文献检索，以确定 RA 的临床试验，与常规护理相比，评估了严格的控制策略。比较了两种类型的研究：（i）使用疾病活动监测并进行治疗调整的研究，以及（ii）使用疾病活动监测但未进行治疗调整的研究。 PubMed 和 Cochrane 数据库的检索时间为 1995 年至 2009 年。主要结果指标是 28 关节 DAS (DAS-28) 的平均变化，用于随机效应荟萃分析。结果。荟萃分析中纳入了六项关于严格控制 RA 患者的对照试验。在所有试验中，严格控制组治疗的患者的 DAS-28 反应显着高于常规护理治疗的患者 [加权平均差 (WMD) = 0.59，P < 0.001]。此外，与非方案化疾病活动监测 (WMD = 0.25) 相比，通过方案化治疗调整 (WMD = 0.97) 进行的严格控制显着更有效 (P < 0.001)。结论。与常规治疗相比，严格控制 RA 可以带来显着更好的临床结果。建议但未经证实，通过方案化治疗调整进行严格控制比不使用此类方案更有益。
Methods. A systematic literature search was performed to identify clinical trials in RA that evaluated tight control strategies in comparison with usual care. Two types of study were compared: (i) those using disease activity monitoring with protocolized treatment adjustments, and (ii) those using disease activity monitoring without protocolized treatment adjustments. The databases PubMed and Cochrane were searched from 1995 up to 2009. Primary outcome measure was the mean change in the 28-joint DAS (DAS-28), which was used in a random-effects meta-analysis.Results. Six controlled trials regarding tight control in RA patients were included in the meta-analysis. In all trials, patients treated in the tight control arms had significantly higher DAS-28 responses than patients treated according to usual care [weighted mean difference (WMD) = 0.59, P < 0.001]. Moreover, tight control was significantly more effective (P < 0.001) by means of protocolized treatment adjustments (WMD = 0.97) compared with non-protocolized monitoring of disease activity (WMD = 0.25).Conclusion. Tight control in RA resulted in significantly better clinical outcomes than usual care. It is suggested but not proved that tight control with protocolized treatment adjustments is more beneficial than if no such protocol is used.