Effect of Biologics in Subgroups of Axial Spondyloarthritis Based on Magnetic Resonance Imaging and C-Reactive Protein: A Systematic Review and Meta-Analysis.
Effect of Biologics in Subgroups of Axial Spondyloarthritis Based on Magnetic Resonance Imaging and C-Reactive Protein: A Systematic Review and Meta-Analysis.
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DOI：
10.1002/acr2.11581
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发表时间：
2023-09
影响因子：
3.4
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中科院分区：
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根据磁共振成像（MRI）和C反应蛋白（CRP）结果确定生物制剂的疗效是否不同。我们比较了来自随机对照试验（RCT）的四个亚组（MRI+/CRP+、MRI +/CRP−、MRI−/CRP+、MRI−/CRP−）。进行了全面的数据库检索，以纳入不同MRI和CRP亚组报告治疗疗效的中轴性脊柱关节炎（axSpA;放射学axSpA [r‐axSpA]和非放射学axSpA [nr‐axSpA]）RCT。使用随机效应模型汇总研究特异性疾病活动评分（12 - 16周），并在4个亚组之间进行比较。纳入了5项试验（均为nr‐axSpA）：3项使用肿瘤坏死因子抑制剂（TNFi，N = 729），2项使用白细胞介素17抑制剂（IL‐ 17 i，N = 794）。基于脊柱关节炎国际协会评估40（ASAS 40）和Bath强直性脊柱炎疾病活动指数50（BASDAI 50），TNFi和IL-17 i在所有MRI和CRP亚组中均显示出疗效，但CRP−/MRI−亚组除外，该亚组仅进行了一项研究，仅纳入39例患者。在达到ASAS 40（P = 0.60，I2 = 0%）或BASDAI 50（P = 0.27，I2 = 23.9%）的患者方面，四个亚组之间无统计学显著差异。CRP+/MRI+和CRP+/MRI-亚组需要治疗的人数为3人，CRP-/MRI+和CRP-/MRI-亚组需要治疗的人数为6人。所有试验的偏倚风险均较低。研究间异质性为低至中度。类似地，比较TNFi或IL-17 i与安慰剂的敏感性分析显示，在ASAS 40（TNFi，P = 0.57; IL-17 i，P = 0.28）和BASDAI 50（TNFi，P = 0.37; IL-17 i，P = 0.18）方面，亚组之间没有差异。在这项系统性综述中，根据ASAS 40或BASDAI 50，四个亚组之间的疗效没有统计学显著差异。
To determine if the efficacy of biologics differ based on magnetic resonance imaging (MRI) and C‐reactive protein (CRP) findings. We compared four subgroups (MRI+/CRP+, MRI+/CRP−, MRI−/CRP+, MRI−/CRP−) from randomized controlled trials (RCTs). A comprehensive database search was performed to include axial spondylarthritis (axSpA; both radiographic axSpA [r‐axSpA] and nonradiographic axSpA [nr‐axSpA]) RCTs with treatment efficacy reported by different MRI and CRP subgroups. Study‐specific disease activity scores (at 12‐16 weeks) were pooled using a random‐effects model and compared between the four subgroups. Five trials (all nr‐axSpA) were included: three with tumor necrosis factor inhibitors (TNFi, N = 729) and two with interleukin‐17 inhibitors (IL‐17i, N = 794). TNFi and IL‐17i showed efficacy based on the Assessment of Spondyloarthritis International Society 40 (ASAS40) and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) in all MRI and CRP subgroups, except the CRP−/MRI− subgroup, which had a single study with only 39 patients. There was no statistically significant difference between the four subgroups in terms of patients achieving ASAS40 (P = 0.60, I2 = 0%) or BASDAI50 (P = 0.27, I2 = 23.9%). The number needed to treat was three for the CRP+/MRI+ and CRP+/MRI− subgroups and six for the CRP−/MRI+ and CRP−/MRI− subgroups. All trials had a low risk of bias. Between‐study heterogeneity was low to moderate. Sensitivity analyses comparing TNFi or IL‐17i versus placebo similarly showed no difference between subgroups in terms of ASAS40 (TNFi, P = 0.57; IL‐17i, P = 0.28) and BASDAI50 (TNFi, P = 0.37; IL‐17i, P = 0.18). In this systematic review, there was no statistically significant difference between the four subgroups in terms of efficacy based on ASAS40 or BASDAI50.