Similar Effects of Disease-Modifying Antirheumatic Drugs, Glucocorticoids, and Biologic Agents on Radiographic Progression in Rheumatoid Arthritis Meta-Analysis of 70 Randomized Placebo-Controlled or Drug-Controlled Studies, Including 112 Comparisons
Similar Effects of Disease-Modifying Antirheumatic Drugs, Glucocorticoids, and Biologic Agents on Radiographic Progression in Rheumatoid Arthritis Meta-Analysis of 70 Randomized Placebo-Controlled or Drug-Controlled Studies, Including 112 Comparisons
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DOI：
10.1002/art.27592
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发表时间：
2010-10-01
影响因子：
--
通讯作者：
Jurgens, Gesche
中科院分区：
文献类型：
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作者：
Graudal, Niels;Jurgens, Gesche
客观的。旨在确定单用和联合缓解病情抗风湿药物 (DMARD)、糖皮质激素和生物制剂治疗对类风湿关节炎 (RA) 患者关节破坏的影响的差异。方法。 RA 患者的随机对照试验，调查药物治疗对年度放射学进展率 (PARPR) 百分比的影响，被纳入根据系统评价和荟萃分析首选报告项目 (PRISMA) 声明方案，使用 Review Manager 5.0 软件进行的荟萃分析。结果。 21 项荟萃分析总结了 70 项试验的数据（112 项比较，16 项干预措施）。与安慰剂相比，单一 DMARD 组的 PARPR 降低了 0.65%（P < 0.002），糖皮质激素组的 PARPR 降低了 0.54%（P < 0.00001）。与单一 DMARD 治疗相比，联合 DMARD 组的 PARPR 小 0.62%（P < 0.001），生物制剂加甲氨蝶呤（MTX）组的 PARPR 小 0.61%（P < 0.00001）。 2 种 DMARD 联合降压糖皮质激素的效果与生物制剂加 MTX 的效果没有差异（百分比平均差 -0.07% [95% 置信区间 -0.25, 0.11]）（P = 0.44）。结论。 DMARD、糖皮质激素、生物制剂和联合药物治疗可显着减少 1 年时的放射学进展，相对效果为 48-84%。生物制剂加 MTX 的组合与 2 种 DMARD 加上初始糖皮质激素的组合之间的直接比较显示没有差异。因此，生物制剂仍应保留给对 DMARD 治疗耐药的 RA 患者。未来生物制剂对 RA 疗效的试验应将此类药物与 DMARD 和糖皮质激素的联合治疗进行比较。
Objective. To define the differences in effects on joint destruction in rheumatoid arthritis (RA) patients between therapy with single and combination disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, and biologic agents.Methods. Randomized controlled trials in RA patients, investigating the effects of drug treatment on the percentage of the annual radiographic progression rate (PARPR) were included in a meta-analysis performed with the use of Review Manager 5.0 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement protocol.Results. Data from 70 trials (112 comparisons, 16 interventions) were summarized in 21 meta-analyses. Compared with placebo, the PARPR was 0.65% smaller in the single-DMARD group (P < 0.002) and 0.54% smaller in the glucocorticoid group (P < 0.00001). Compared with single-DMARD treatment, the PARPR was 0.62% smaller in the combination-DMARD group (P < 0.001) and 0.61% smaller in the biologic agent plus methotrexate (MTX) group (P < 0.00001). The effect of a combination of 2 DMARDs plus step-down glucocorticoids did not differ from the effect of a biologic agent plus MTX (percentage mean difference -0.07% [95% confidence interval -0.25, 0.11]) (P = 0.44).Conclusion. Treatment with DMARDs, glucocorticoids, biologic agents, and combination agents significantly reduced radiographic progression at 1 year, with a relative effect of 48-84%. A direct comparison between the combination of a biologic agent plus MTX and the combination of 2 DMARDs plus initial glucocorticoids revealed no difference. Consequently, biologic agents should still be reserved for patients whose RA is resistant to DMARD therapy. Future trials of the effects of biologic agents on RA should compare such agents with combination treatments involving DMARDs and glucocorticoids.