瘤坏死因子 (TNF) 抑制剂用于牛皮关节炎
Giovanni Cagnotto1,2, Matteo Bruschettini3,4, Agata Stróżyk5
1Clinical Sciences Malmö, Lund University, Malmö, Sweden.
The Cochrane database of systematic reviews
|February 13, 2025
概括
瘤坏死因子抑制剂 (TNFi) 可能会改善牛皮关节炎症状和疾病活性,这些患者对常规合成疾病修饰性抗风湿药物 (csDMARDs) 的反应不足. 虽然TNFi可能会稍微增加不良事件的撤回,但与安慰剂相比,它们在严重不良事件中几乎没有差异.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 牛皮关节炎 (PsA) 是一种与牛皮相关的慢性炎症状况,如果不治疗,可能会导致残疾.
- 目前的治疗方法包括NSAIDs,皮质类固醇,csDMARDs,bDMARDs和tsDMARDs,瘤缩因子抑制剂 (TNFi) 是一种首选的生物选择.
研究的目的:
- 评估TNFi在被诊断患有牛皮关节炎的成年患者中的疗效和安全性.
- 将TNFi与安慰剂和其他疾病修饰性抗风湿药物 (DMARD) 进行比较,用于管理PSA.
主要方法:
- 25项随机对照试验 (RCT) 的系统审查和元分析,涉及7857名参与者.
- 主要比较侧重于TNFi与安慰剂在对csDMARDs反应不足的患者中.
- 评估结果包括临床改善,最小的疾病活性,身体功能,生活质量,放射性进展和不良事件.
主要成果:
- 中等确定性证据表明,TNFi显著改善了csDMARD-不充分响应者中的临床结果 (ACR50) 和与安慰剂相比的最小疾病活性.
- TNFi可能会提高与健康有关的生活质量,并略有减少放射性进展,尽管对功能改善的证据的确定性很低.
- 与安慰剂相比,TNFi在严重不良事件中差异很小,但由于不良事件而导致的退出可能略有增加.
结论:
- 在患有PsA且对csDMARDs反应不足的患者中,TNFi提供了实质性的临床益处,包括改善疾病活性,生活质量和减少放射性进展.
- 安全性概况表明,不良事件的风险是可以管理的,治疗中断的几率略有增加,但严重不良事件的数量没有显著增加.
- 需要在以前没有使用DMARD的群体和对bDMARD/tsDMARD耐药群体中对TNFi进行进一步的研究,因为没有确定相关的试验.
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