临床实践中类风湿性关节炎治疗方法的比较有效性:系统性审查
Jeffrey A Sparks1, Leslie R Harrold2, Teresa A Simon3
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Seminars in arthritis and rheumatism
|August 13, 2023
概括
生物 (b) 和有针对性的合成 (t) 疾病修饰性抗风湿药 (DMARDs) 提供有效的类风湿性关节炎 (RA) 治疗选择. 然而,现实世界的证据表明,在RA管理方面,一个bDMARD或tsDMARD对另一个没有明显的优势.
科学领域:
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
- 临床有效性研究研究 临床有效性研究
背景情况:
- 类风湿性关节炎 (RA) 管理依赖于各种生物 (b) 和向性合成 (ts) 疾病修饰性抗风湿药物 (DMARDs).
- 现实世界的比较疗效数据对于指导RA患者的治疗决策至关重要.
研究的目的:
- 系统地审查bDMARDs和tsDMARDs在成年RA患者中的实际比较有效性研究.
- 综合不同bDMARDs和tsDMARDs的比较疗效的证据,使用已建立的结果指标.
主要方法:
- 在Medline和Embase的系统文献搜索中,对非随机化研究 (2001-2021) 进行比较,比较b/tsDMARDs在RA中.
- 包括报告ACR推的疾病活动,功能状态和患者报告的结果的研究.
- 使用Cochrane RoBINS-I工具进行偏差风险评估;由于异质性,不能进行元分析.
主要成果:
- 选择了68项研究,主要是2011-2021年出版的多中心观察队列/注册表 (n=60).
- 常见的结局包括疾病活动评分 (46项研究) 和健康评估问卷 (32项研究).
- 不同的bDMARDs和tsDMARDs之间没有观察到临床有效性的显著差异.
结论:
- 现实世界的证据表明,RA有多种有效的治疗选择,有限的数据支持一种bDMARD或tsDMARD而不是其他药物.
- 个性化RA治疗策略是必不可少的,根据患者个人资料量身定制.
- 需要进一步的研究来确定特定药物类别在不同患者子组中的潜在益处.
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