瘤坏死因子 (TNF) 抑制剂用于青少年异常性关节炎
Giovanni Cagnotto1,2, Carsten B Juhl3,4, Fredrik Ahlström5
1Clinical Sciences Malmö, Lund University, Malmö, Sweden.
The Cochrane database of systematic reviews
|February 20, 2025
概括
与安慰剂相比,瘤坏死因子抑制剂 (TNFi) 可能会改善青少年异常性关节炎 (JIA) 的治疗反应. 然而,TNFi的证据是:
科学领域:
- 类风湿病学 类风湿病学
- 儿科风湿病学 儿科风湿病学
- 临床试验 临床试验
背景情况:
- 青春期异常性关节炎 (JIA) 是16岁以下儿童的慢性炎症性关节疾病.
- 目前的治疗方法包括NSAIDs,皮质类固醇,csDMARDs (例如,甲铁),bDMARDs (例如,TNFi) 和tsDMARDs.
- TNFi是针对瘤死因子的生物药物,这是JIA的关键炎症调解剂.
研究的目的:
- 评估瘤亡因子抑制剂 (TNFi) 在治疗青少年异常性关节炎 (JIA) 的益处和危害.
- 在儿科患者中比较TNFi的疗效和安全性与安慰剂和甲状腺素 (MTX) 相比.
- 综合来自TNFi的随机对照试验 (RCT) 的证据,用于JIA管理.
主要方法:
- 在多个数据库 (CENTRAL,MEDLINE,Embase,ClinicalTrials.gov,WHO ICTRP) 进行系统搜索,截至2024年2月.
- 包括RCT,准RCT和戒断试验,将TNFi与安慰剂,MTX或其他DMARDs进行比较.
- 主要结局包括治疗反应 (pedACR70),疼痛,功能,整体幸福感,缓解和不良事件.
主要成果:
- 七项研究 (570名参与者) 将TNFi与安慰剂进行比较;低确定性证据表明TNFi可能会增加治疗反应 (pedACR70: 34%对14%).
- 与安慰剂相比,TNFi对疼痛,功能和生活质量的影响的证据非常不确定.
- 与安慰剂相比,TNFi对不良事件和严重不良事件的影响存在不确定性;单独TNFi + MTX与MTX的数据也有限,确定性非常低.
结论:
- 与安慰剂相比,TNFi可能会改善JIA患者的临床改善,但关于疼痛,功能和生活质量的证据尚不确定.
- 与甲醇相结合的TNFi的益处和危害与单独的甲醇相比仍然不清楚.
- 需要高质量的研究来最终评估TNFi在青少年异常性关节炎的疗效和安全性.
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