Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis.
Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis.
复制标题
DOI：
10.1371/journal.pone.0030275
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Blom M
中科院分区：
文献类型：
--
作者：
Aaltonen KJ;Virkki LM;Malmivaara A;Konttinen YT;Nordström DC;Blom M
五种肿瘤坏死因子（TNF）阻滞剂（英夫利昔单抗、依那西普、阿达木单抗、certolizumab pegol和golimumab）可用于治疗类风湿性关节炎。只有少数临床试验比较一种tnf阻滞剂与另一种。因此，需要进行系统的评价来间接比较这些物质。本研究的目的是评估tnf阻滞剂治疗类风湿关节炎（RA）的有效性和安全性，并通过结合随机临床试验（RCT）的结果间接比较目前所有五种可用的阻滞剂。使用MEDLINE、SCOPUS（包括EMBASE）、Cochrane图书馆和电子检索警报等数据库进行系统文献综述。本研究只选择了tnf受体阻滞剂与安慰剂联合或不联合甲氨蝶呤（MTX）治疗类风湿关节炎的双盲随机对照试验。收集的数据包括患者、干预措施、对照、结果、研究方法和最终偏倚来源的信息。系统评价和荟萃分析纳入了报道26项随机对照试验的41篇文章。5项随机对照试验研究了英夫利昔单抗、7项依那西普、8项阿达木单抗、3项戈利姆单抗和3项certolizumab。tnf -阻滞剂在所有时间点都比安慰剂更有效，但与MTX相当。tnf -阻滞剂和MTX联合使用优于单独使用MTX或tnf -阻滞剂。增加剂量并没有提高疗效。与甲氨蝶呤或安慰剂相比，tnf受体阻滞剂相对安全。没有一种物质的疗效明显高于其他物质，但安全性分析的结果表明，依那西普可能是最安全的替代品。有趣的是，考虑到疗效和安全性方面的成本边际，MTX的表现几乎相同。
Five-tumour necrosis factor (TNF)-blockers (infliximab, etanercept, adalimumab, certolizumab pegol and golimumab) are available for treatment of rheumatoid arthritis. Only few clinical trials compare one TNF-blocker to another. Hence, a systematic review is required to indirectly compare the substances. The aim of our study is to estimate the efficacy and the safety of TNF-blockers in the treatment of rheumatoid arthritis (RA) and indirectly compare all five currently available blockers by combining the results from included randomized clinical trials (RCT). A systematic literature review was conducted using databases including: MEDLINE, SCOPUS (including EMBASE), Cochrane library and electronic search alerts. Only articles reporting double-blind RCTs of TNF-blockers vs. placebo, with or without concomitant methotrexate (MTX), in treatment of RA were selected. Data collected were information of patients, interventions, controls, outcomes, study methods and eventual sources of bias. Forty-one articles reporting on 26 RCTs were included in the systematic review and meta-analysis. Five RCTs studied infliximab, seven etanercept, eight adalimumab, three golimumab and three certolizumab. TNF-blockers were more efficacious than placebo at all time points but were comparable to MTX. TNF-blocker and MTX combination was superior to either MTX or TNF-blocker alone. Increasing doses did not improve the efficacy. TNF-blockers were relatively safe compared to either MTX or placebo. No single substance clearly rose above others in efficacy, but the results of the safety analyses suggest that etanercept might be the safest alternative. Interestingly, MTX performs nearly identically considering both efficacy and safety aspects with a margin of costs.
登录
查看更多内容
影响因子：
--
作者：
Goekoop-Ruiterman, YPM;de Vries-Bouwstra, JK;Dijkmans, C
通讯作者：
Dijkmans, C
影响因子：
3.2
作者：
Chen, Der-Yuan;Chou, Show-Jan;Lan, Joung-Liang
通讯作者：
Lan, Joung-Liang
影响因子：
27.4
作者：
Durez, P;Toukap, AN;Houssiau, FA
通讯作者：
Houssiau, FA
影响因子：
2.3
作者：
Alonso-Ruiz, Alberto;Pijoan, Jose Ignacio;Quintana, Antonio
通讯作者：
Quintana, Antonio
影响因子：
--
作者：
Emery, Paul;Breedveld, Ferdinand;Freundlich, Bruce
通讯作者：
Freundlich, Bruce