生物療法で治療されたリウマチ性関節炎患者の悪性腫瘍のリスク:メタ解析
Maria A Lopez-Olivo1, Jean H Tayar, Juan A Martinez-Lopez
1University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
JAMA
|September 6, 2012
まとめ
リウマチ性関節炎 (RA) の生物学的応答変容剤 (BRM) は,ランダム化制御試験では悪性腫瘍のリスクの増加を示さなかった. この研究では,BRMの使用とRA患者の癌発症との間に有意な関連性が見出されなかった.
科学分野:
- レウマトロジーの病理学
- 腫瘍学 腫瘍学
- クリニック・トライアル 臨床試験
背景:
- リウマチ性関節炎 (RA) 患者における潜在的な悪性腫瘍に関する懸念は,生物学的応答変形剤 (BRM) で治療された患者において存在します.
- RAにおけるBRMに関連した癌リスクの評価は,患者の安全性および治療決定において極めて重要です.
研究 の 目的:
- 生物学的応答修正剤 (BRM) のランダム化対照試験 (RCT) に参加するリウマチ性関節炎 (RA) 患者における悪性腫瘍のリスクを評価する.
主な方法:
- RCTについては,電子データベース,会議の議事録,規制機関のウェブサイトを体系的に検索した.
- 含まれるRCTは,少なくとも24週間のフォローアップで,プラセボまたは従来の疾患修飾抗レウマティック薬 (DMARDs) に対してRAのBRMを比較した.
- データの抽出と品質評価は独立して行われ,各BRMに対して集積された推定値と信頼区間が計算された.
主要な成果:
- RA患者29,423人を対象とした63件のRCTを分析した.
- BRMの使用で悪性腫瘍の全体的なリスクの統計的に有意な増加は観察されなかった.
- 治療の最初の1年以内に悪性腫瘍の発生率は,BRM群と対照群では低いもので,アナキンラとメトトレキサート併用の1例は,メトトレキサート単独と比較して確率が低下したことを示した.
結論:
- 少なくとも6ヶ月間のRCT内のRA患者のBRMの使用は,悪性腫瘍のリスクの増加と有意に関連していません.
- 発見は,RA患者のプラセボまたは従来のDMARDと比較して,BRMをがんリスクに関して安全に使用できることを示唆しています.
関連する概念動画
Genome-wide Association Studies-GWAS
12.6K
Genome-wide association studies or GWAS are used to identify whether common SNPs are associated with certain diseases. Suppose specific SNPs are more frequently observed in individuals with a particular disease than those without the disease. In that case, those SNPs are said to be associated with the disease. Chi-square analysis is performed to check the probability of the allele likely to be associated with the disease.
GWAS does not require the identification of the target gene involved in...
GWAS does not require the identification of the target gene involved in...
12.6K
The JAK-STAT Signaling Pathway
10.2K
Several cytokine receptors have tightly bound Janus kinase or JAK proteins attached at their cytosolic tail. Small signaling molecules such as cytokines, growth hormones, or prolactins bind to the cytokine receptors and initiate their dimerization. The dimerization brings the cytosolic JAKs together that trans-phosphorylate and activates each other. The activated JAKs now phosphorylate cytosolic tails of the cytokine receptors, which serve as binding sites for adaptor proteins such as SH2...
10.2K
T Cell Types and Functions
3.2K
When T cells with CD4 markers are activated, they give rise to two types of effector cells: helper T cells and regulatory T cells. Meanwhile, T cells with CD8 markers differentiate into effector cytotoxic T cells. The differentiation of CD4 T cells into helper T cell subsets, such as Th1, Th2, and Th17 cells, is dependent on the antigen type, antigen-presenting cell, and regulatory cytokines.
Th1 cells stimulate dendritic cells to express necessary co-stimulatory molecules on their surfaces for...
Th1 cells stimulate dendritic cells to express necessary co-stimulatory molecules on their surfaces for...
3.2K
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
755
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
755
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
880
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
880
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
627
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
627


