甲托雷克萨特治疗青少年异常性关节炎
Joachim Tan1,2, William D Renton2,3,4, Samuel L Whittle2,5
1Department of Rheumatology, Children's Health Queensland, South Brisbane, Australia.
The Cochrane database of systematic reviews
|February 9, 2024
概括
甲托雷克萨特可以改善青少年异常性关节炎 (JIA) 的治疗反应,但对疼痛的影响很小. 严重的不良事件很少发生,支持其作为疾病修饰性抗风湿药物 (DMARD) 在JIA管理中的使用.
科学领域:
- 儿科风湿病学 儿科风湿病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 青少年异常性关节炎 (JIA) 是童年最常见的类风湿性疾病.
- 甲甲酸是一种广泛使用的疾病修饰性抗风湿药物 (DMARD),具有广泛的免疫调节作用.
- 这次审查是2001年科克莱恩审查的更新,支持JIA的指导方针.
研究的目的:
- 评估在被诊断患有JIA的儿童和青少年中甲铁酸的益处和危害.
- 综合来自随机对照试验 (RCT) 关于甲状腺素的疗效和安全性的证据.
- 为临床实践和JIA治疗指南的制定提供信息.
主要方法:
- 在多个数据库 (CENTRAL,MEDLINE,Embase,试验注册) 进行系统搜索,截至2023年2月1日.
- 包括将甲状腺素与安慰剂,无治疗或其他儿童JIA患者的DMARDs进行比较的RCT.
- 评估结果,包括治疗反应,疾病活性,功能,疼痛,不良事件和戒断,使用GRADE标准.
主要成果:
- 包括五个RCT (575名参与者). 甲甲酸与安慰剂相比,可能会增加治疗反应 (低确定性证据),但对疼痛或幸福感的影响很小.
- 甲托雷克萨特加上关节内葡萄糖皮质类药物治疗对原关节性JIA持续不活性的疾病几乎没有影响.
- 甲托雷克萨特与莱夫卢诺米德对治疗反应或功能的影响很小,对所有结果的证据确定性低.
结论:
- 与安慰剂相比,甲托雷克萨特可能会增强JIA的治疗反应,但对疼痛和幸福感的影响很小.
- 证据表明,当甲状腺素与关节内葡萄皮质类药物结合用于关节性JIA时,甲状腺素的额外益处有限.
- 甲基似乎是一个安全的选择,罕见的严重不良事件,支持其在JIA管理中的作用.
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