Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis.
Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis.
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DOI：
10.1136/rmdopen-2014-000017
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发表时间：
2015
期刊：
影响因子：
6.2
通讯作者：
Gomez-Reino JJ
中科院分区：
文献类型：
--
作者：
Maneiro JR;Souto A;Salgado E;Mera A;Gomez-Reino JJ
目的：确定强直性脊柱炎(AS)和银屑病关节炎(PSA)患者对肿瘤坏死因子(TNF)拮抗剂反应的预测因素。在系统检索的基础上对临床试验和观察性研究进行系统回顾和荟萃分析。使用随机效应计算汇总OR对相似观察进行Meta分析。异质性使用I2检验，偏倚风险使用漏斗图和Egger检验。用Meta回归分析异质性的原因。电子检索获得了1340篇参考文献和217篇摘要。手工检索后又鉴定出17篇文章。本研究共收集59篇符合研究目的的文献进行综述。37篇文章(33篇研究)包括6736例强直性脊柱炎患者，23篇文章(22篇研究)包括4034例PSA患者。1篇文章包括AS和PSA的数据。年龄(OR(95%CI)0.91(0.84~0.99)，I2=84.1%)，性别(1.57(1.10~2.25)，I2=0.0%)，基线BASDAI(1.31(1.09~1.57)，I2=0.0%)，基线BASFI(0.86(0.79~0.93)，I2=24.9%)，基线C反应蛋白(CRP)(2.14(1.71~2.68)，I2=22.3%)和人类白细胞抗原B27(HLAB27)(1.81(1.35~2.42)，I2=0.0%)预测AS的BASDAI50反应。没有任何因素被确定为异质性的来源。只有基线BASFI的Meta分析显示有发表偏倚的风险(Egger检验，p=0.004)。在标准反应中也发现了类似的结果.在PSA中没有发现反应的预测因素。年龄小、男性、高基线BASDAI、低基线BASFI、高基线CRP和高HLAB27预示AS患者对肿瘤坏死因子拮抗剂的反应较好，而PSA患者则不然。
To identify predictors of response to tumor necrosis factor (TNF) antagonists in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Systematic review and meta-analysis of clinical trials and observational studies based on a systematic search. Meta-analyses of similar observations were performed using random effects computing summary OR. Heterogeneity was tested using I2, and risks of bias using funnel plots and the Egger test. Meta-regression was used to explore causes of heterogeneity. The electronic search captured 1340 references and 217 abstracts. 17 additional articles were identified after searching by hand. A total of 59 articles meet the purpose of the study and were reviewed. 37 articles (33 studies) included 6736 patients with AS and 23 articles (22 studies) included 4034 patients with PsA. 1 article included data on AS and PsA. Age (OR (95% CI) 0.91 (0.84 to 0.99), I2=84.1%), gender (1.57 (1.10 to 2.25), I2=0.0%), baseline BASDAI (1.31 (1.09 to 1.57), I2=0.0%), baseline BASFI (0.86 (0.79 to 0.93), I2=24.9%), baseline dichotomous C reactive protein (CRP) (2.14 (1.71 to 2.68), I2=22.3%) and human leucocyte antigen B27 (HLA-B27) (1.81 (1.35 to 2.42), I2=0.0%) predict BASDAI50 response in AS. No factor was identified as a source of heterogeneity. Only meta-analysis of baseline BASFI showed risk of publication bias (Egger test, p=0.004). Similar results were found for ASAS criteria response. No predictors of response were identified in PsA. Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.