Effectiveness and Safety of Iguratimod Monotherapy or Combined With Methotrexate in Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

类风湿性关节炎 医学 甲氨蝶呤 内科学 随机对照试验 荟萃分析 药理学
作者
Dan Ouyang,Yuan Zhi,Jie Zou,Yong Long Wang,Zheng Chen,Yu Ying Yang,Bin Zou,Xin Li,Jian Zhong Cao
出处
期刊:Frontiers in Pharmacology [Frontiers Media SA]
卷期号:13 被引量:8
标识
DOI:10.3389/fphar.2022.911810
摘要

Objectives: We aimed to estimate the effectiveness and safety of iguratimod (IGU) monotherapy or in combination with methotrexate (MTX) in treating rheumatoid arthritis (RA) to provide an evidence-primarily-based foundation for clinical application. Methods: We conducted a systematic review of the meta-analysis using eight databases and two clinical trial websites searching for randomized controlled trials (RCTs) from conception to 15 March 2022, based on outcomes of patients with RA treated with IGU. The evidence quality assessment of primary outcomes was evaluated by the GRADE tool, and RevMan 5.3 and StataMP 14.0 were used to perform this research. Results: A total of 4302 patients with RA from 38 RCTs was included in this research. Pooled results demonstrated as follows: 1) Compared with methotrexate (MTX) alone, IGU alone was superior in improving ACR20 and DAS28-ESR, while having no significant difference in ACR50 and ACR70 [ACR20: (RR 1.15, 95% CI 1.05-1.27, p = 0.004); ACR50: (RR 0.97, 95% CI 0.66-1.44, p = 0.88); ACR70: (RR 0.92, 95% CI 0.45-1.90, p = 0.83); DAS28-ESR: mean difference (MD) -0.15, 95% CI -0.27 to -0.03, p = 0.01]. 2) Compared with MTX alone, IGU + MTX was more effective in improving ACR20, ACR50, ACR70, and DAS28-ESR. [ACR20: (RR 1.24, 95% CI 1.14-1.35, p < 0.00001); ACR50: (RR 1.96, 95% CI 1.62-2.39, p <0.00001); ACR70: (RR 1.91, 95% CI 1.41-2.57, p < 0.0001)]; [DAS28-ESR: (MD) -1.43, 95% CI -1.73 to -1.12, p < 0.00001]. 3) Compared with MTX + leflunomide (LEF), ACR20, ACR50, ACR70, and DAS28-ESR of IGU + MTX had no significant difference [ACR20: (RR 1.06, 95% CI 0.94-1.19, p = 0.38); ACR50: (RR 1.10, 95% CI 0.66-1.84, p = 0.72); ACR70: (RR 1.20, 95% CI 0.45-3.20, p = 0.71); DAS28-ESR: (MD -0.02, 95% CI -0.13 to -0.10, p = 0.77)]. 4) Compared with MTX + hydroxychloroquine (HCQ), IGU + MTX was superior in improving DAS28-ESR (MD -2.16, 95% CI -2.53 to -1.79, p < 0.00001). 5) Compared with MTX + tripterygium glycosides (TGs), IGU + MTX was more effective in improving DAS28-ESR (MD -0.94, 95% CI -2.36 to 0.48, p = 0.19). 6) There were no significant differences in adverse events (AEs) between the groups of IGU vs. MTX (RR 0.96, 95% CI 0.71-1.31, p = 0.80), IGU + MTX vs. MTX (RR 1.10, 95% CI 0.90-1.35, p = 0.34), IGU + MTX vs. MTX + HCQ (RR 0.64, 95% CI 0.29-1.42, p = 0.27), and IGU + MTX vs. MTX + TGs (RR 0.75, 95% CI 0.28-2.02, p = 0.57). The incidence of AEs in the IGU + MTX group was lower than the MTX + LEF group (RR 0.83, 95% CI 0.71-0.98, p = 0.03). Conclusion: Compared to the MTX alone subgroup, IGU alone offers clear advantages in improving ACR20 and DAS28-ESR, despite the insufficient evidence for DAS28-ESR findings. IGU + MTX shows clear benefits in improving ACR20, ACR50, ACR70, and DAS28-ESR scores compared to standard therapies. When the intervention (IGU alone or IGU + MTX) lasted for 52 weeks, it demonstrated superior efficacy in improving ACR20 of patients without prominent adverse events. Notably, IGU or IGU + MTX has apparent advantages in improving ACR20 of first-visit RA, and IGU + MTX has obvious advantages in improving DAS28-ESR of refractory RA. Furthermore, IGU + MTX does not increase the risk of leukopenia, but it can decrease the risk of liver function tests (LFTs), regardless of the age or the stage of RA. Clinical Trial Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022295217.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
fanlin完成签到,获得积分10
1秒前
小丸子86完成签到,获得积分10
1秒前
Able磕颜发布了新的文献求助10
2秒前
Ava应助LL采纳,获得10
2秒前
想人陪的以云完成签到,获得积分10
2秒前
苒柒完成签到,获得积分10
3秒前
LLLLL完成签到,获得积分10
3秒前
wyq发布了新的文献求助10
3秒前
鉨汏闫完成签到,获得积分10
3秒前
倩倩完成签到,获得积分10
3秒前
妖娆完成签到,获得积分10
4秒前
深情安青应助sun采纳,获得10
5秒前
飞云完成签到,获得积分10
5秒前
莫羽倾尘完成签到,获得积分10
5秒前
蕾蕾完成签到 ,获得积分10
5秒前
6秒前
打打应助小饼干采纳,获得10
6秒前
6秒前
6秒前
钮以南完成签到,获得积分10
6秒前
上官若男应助小children丙采纳,获得10
6秒前
AQ完成签到,获得积分10
6秒前
小舒完成签到 ,获得积分10
6秒前
藏识完成签到,获得积分10
7秒前
7秒前
哈哈完成签到,获得积分10
7秒前
终于花开日完成签到 ,获得积分10
8秒前
dominic12361完成签到 ,获得积分10
8秒前
8秒前
破晓完成签到 ,获得积分10
8秒前
Atalanta完成签到,获得积分10
9秒前
开心的半仙完成签到 ,获得积分10
9秒前
iufan发布了新的文献求助10
9秒前
10秒前
积极冷霜发布了新的文献求助10
10秒前
曲终人散发布了新的文献求助10
10秒前
狂野的以珊完成签到,获得积分10
10秒前
10秒前
木木完成签到,获得积分10
11秒前
小白求文章完成签到,获得积分10
11秒前
高分求助中
Sustainability in Tides Chemistry 2800
The Young builders of New china : the visit of the delegation of the WFDY to the Chinese People's Republic 1000
Rechtsphilosophie 1000
Bayesian Models of Cognition:Reverse Engineering the Mind 888
Le dégorgement réflexe des Acridiens 800
Defense against predation 800
A Dissection Guide & Atlas to the Rabbit 600
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3134302
求助须知:如何正确求助?哪些是违规求助? 2785212
关于积分的说明 7770748
捐赠科研通 2440808
什么是DOI,文献DOI怎么找? 1297536
科研通“疑难数据库(出版商)”最低求助积分说明 624987
版权声明 600792