Induction maintenance with tumour necrosis factor-inhibitor combination therapy with discontinuation versus methotrexate monotherapy in early rheumatoid arthritis: a systematic review and meta-analysis of efficacy in randomised controlled trials
Induction maintenance with tumour necrosis factor-inhibitor combination therapy with discontinuation versus methotrexate monotherapy in early rheumatoid arthritis: a systematic review and meta-analysis of efficacy in randomised controlled trials
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DOI：
10.1136/rmdopen-2016-000323
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发表时间：
2016-12-01
期刊：
影响因子：
6.2
通讯作者：
van Vollenhoven, Ronald
中科院分区：
文献类型：
--
作者：
Emamikia, Sharzad;Arkema, Elizabeth V.;van Vollenhoven, Ronald
目的：确定联合治疗(甲氨蝶呤（MTX)+肿瘤坏死因子（TNF）抑制剂（TNFi））的诱导维持策略，然后停用TNFi是否比单独使用MTX治疗的策略能产生更好的长期结果，因为目前尚不清楚如果停用TNFi，联合治疗的诱导阶段的益处是否能持续。方法：我们对早期类风湿性关节炎（RA）患者使用MTX+TNFi初始联合治疗常规合成疾病改善抗风湿药物的试验进行了荟萃分析。对诱导维持随机对照试验（rct）进行了系统的文献检索，其中对临床活动性早期RA患者的初始联合治疗与MTX单药治疗进行了比较。我们的主要结局是达到低疾病活动性（LDA）和疾病活动性评分（DAS） 28的患者比例
Objective: To determine whether an inductionmaintenance strategy of combined therapy (methotrexate (MTX)+tumour necrosis factor (TNF) inhibitor (TNFi)) followed by withdrawal of TNFi could yield better long-term results than a strategy with MTX monotherapy, since it is unclear if the benefits from an induction phase with combined therapy are sustained if TNFi is withdrawn.Methods: We performed a meta-analysis of trials using the initial combination of MTX+TNFi in conventional synthetic disease-modifying antirheumatic drug-naive patients with early rheumatoid arthritis (RA). A systematic literature search was performed for induction-maintenance randomised controlled trials (RCTs) where initial combination therapy was compared with MTX monotherapy in patients with clinically active early RA. Our primary outcome was the proportion of patients who achieved low disease activity (LDA; Disease Activity Score (DAS) 28