生物和靶向合成药物治疗银屑病关节炎的有效性和安全性:系统综述与网络荟萃分析。

IF 2 4区 医学 Q3 RHEUMATOLOGY Advances in Rheumatology Pub Date : 2024-03-21 DOI:10.1186/s42358-024-00361-3
Thais Montezuma, Livia Fernandes Probst, Matheus Oliveira Almeida
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引用次数: 0

摘要

背景:银屑病关节炎(PA)是一种慢性炎症性系统性关节炎,可导致功能丧失和关节变形。本系统综述评估了生物药物和靶向合成药物治疗 PA 的有效性和安全性:我们在主要的通用数据库和临床试验登记数据库中搜索了评估阿达木单抗、依那西普、英夫利昔单抗、戈利木单抗、塞库单抗、赛妥珠单抗Pegol和托法替尼使用情况的随机临床试验(RCT)。主要结果为 ACR 50、PsARC 和严重不良事件。两名独立审稿人负责研究筛选和数据提取。采用随机效应模型和频数主义方法进行网络荟萃分析。CINeMA软件用于评估证据的确定性:我们纳入了 33 项研究性试验(n = 11,034)。随访 6 个月时 ACR 50 的网络荟萃分析结果显示,所有药物的疗效均优于安慰剂,其中塞库单抗(证据确定性高)、英夫利昔单抗(证据确定性极低)和阿达木单抗(证据确定性高)的疗效最高。关于PsARC(随访6个月),除戈利木单抗(证据确定性很低)外,所有药物均优于安慰剂,其中Etanercept(证据确定性低)、Infliximab(证据确定性低)和Certolizumab Pegol(证据确定性低)是最有效的药物。这些药物与安慰剂在发生严重不良事件的风险方面没有明显差异。戈利木单抗(证据确定性极低)、塞库单抗(证据确定性低)和阿达木单抗(证据确定性极低)的安全性最高:总之,根据疗效和安全性之间的平衡,塞库单抗和阿达木单抗可能是治疗PsA患者的首选药物。然而,在解释安全性结果时必须谨慎,因为这些结果是由低确定性到极低确定性的证据支持的。因此,随着新的安全性评估研究的出现,收益与潜在风险之间的平衡可能会发生变化:PROCEMO:CRD42022315577。
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Effectiveness and safety of biological and target synthetic drugs treatment for psoriatic arthritis: a systematic review with network meta-analysis.

Background: Psoriatic arthritis (PA) is a chronic inflammatory systemic arthritis that can result in loss of functional capacity and joint deformation. This systematic review assessed the effectiveness and safety of biological and target synthetic drugs for treating PA.

Methods: We searched for randomized clinical trials (RCTs) that evaluated the use of Adalimumab, Etanercept, Infliximab, Golimumab, Secukinumab, Certolizumab Pegol and Tofacitinib in the main general databases and clinical trial registers databases. The primary outcomes were ACR 50, PsARC, and serious adverse events. Two independent reviewers performed study selection and data extraction. Network meta-analyses were conducted using a random effects model and frequentist approach. The CINeMA software was used to assess the certainty of evidence.

Results: We included 33 RCTs (n = 11,034). The results from the network meta-analysis for the ACR 50 at 6-months follow-up showed that all drugs were superior to placebo, with Secukinumab (high certainty of evidence), Infliximab (very low certainty of evidence) and Adalimumab (high certainty of evidence) ranking the highest. Regarding the PsARC (at 6-months follow-up), all drugs, except for Golimumab (very low certainty of evidence), were superior to placebo, with Etanercept (low certainty of evidence), Infliximab (low certainty of evidence) and Certolizumab Pegol (low certainty of evidence) being the most effective drugs. There were no significant differences in the risk of serious adverse events between the drugs and placebo. Golimumab (very low certainty of evidence), Secukinumab (low certainty of evidence), and Adalimumab (very low certainty of evidence) ranked the highest for safety.

Conclusions: In conclusion, based on the balance between efficacy and safety, Secukinumab and Adalimumab may be the preferred options among the evaluated drugs for treating patients with PsA. However, caution is necessary when interpreting the safety findings, as they are supported by evidence of low to very low certainty. Consequently, the balance between benefits and potential risks may change as new safety evaluation studies become available.

Protocol registration: PROSPERO: CRD42022315577.

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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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