类风湿关节炎患者服用改变病情抗风湿药与间质性肺病的发病风险：系统回顾和荟萃分析

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism Pub Date : 2024-10-11 DOI:10.1016/j.semarthrit.2024.152561

Qianru Zhang , Gregory C McDermott , Pierre-Antoine Juge , Sung Hae Chang , Kathleen MM Vanni , Grace Qian , Katarina J Bade , Kevin T Mueller , Emily N Kowalski , Alene A Saavedra , Jeffrey A Sparks

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引用次数: 0

摘要

目的通过系统性文献综述和荟萃分析，研究类风湿关节炎（RA）患者中改变病情抗风湿药（DMARDs）与间质性肺病（ILD）发病风险的关系。方法我们对研究类风湿关节炎（RA）患者中改变病情抗风湿药（DMARDs）与间质性肺病（ILD）发病关系的研究进行了系统性文献综述和荟萃分析。我们检索了PubMed、Embase、Web of Science和Cochrane图书馆从开始到2023年11月的随机对照试验（RCT）、观察性研究和上市后监测研究，这些研究调查了成人RA患者，并比较了相关DMARDs与安慰剂、无DMARDs或其他DMARDs。研究结果为ILD事件。我们总结了有关 DMARDs 和 RA-ILD 事件风险的文献。结果在 3,612 项研究中，我们共发现了 40 篇论文，涉及 486,465 例 RA 患者和 3,928 例 ILD 事件，这些论文被纳入了最终的系统综述和荟萃分析。在这些研究中，24篇为RCT研究，4篇为前瞻性队列研究，9篇为回顾性队列研究，2篇为病例对照研究，1篇为上市后监测研究。对 RCT 进行的汇总分析显示，在所有比较研究中，任何特定 DMARD 发生 ILD 的几率均无统计学意义上的显著差异。关于托法替尼（n = 2,911）与肿瘤坏死因子抑制剂（TNFi，n = 1,451）的最大RCT（口服监测试验）研究发现，托法替尼与ILD事件没有关系（OR 0.94，95 %CI 0.52至1.69，p = 0.828）。在 7 项观察性研究中，与未使用 MTX 的患者相比，使用甲氨蝶呤 (MTX) 导致 ILD 的汇总 OR 值为 0.49（95 %CI 0.32 至 0.76，p = 0.001）。在一项观察性研究中，与 TNFi 使用者相比，托法替尼使用者的 ILD OR 为 0.36（95 %CI 0.15 至 0.87，p = 0.024）。然而，这些研究可能容易出现偏倚，而且在RCT研究中，没有特定的DMARD显示与RA-ILD事件有关。要想就DMARDs与RA-ILD风险之间的潜在关系得出明确结论，还需要进一步开展设计良好的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Disease-modifying antirheumatic drugs and risk of incident interstitial lung disease among patients with rheumatoid arthritis: A systematic review and meta-analysis

Objective

To investigate the association of disease-modifying antirheumatic drugs (DMARDs) and risk of incident interstitial lung disease (ILD) among patients with rheumatoid arthritis (RA) using a systematic literature review and meta-analysis.

Methods

We performed a systematic literature review and meta-analysis of studies examining the association of DMARDs with incident RA-ILD. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to November 2023 for randomized controlled trials (RCTs), observational studies, and post-marketing surveillance studies that investigated adults with RA and compared DMARDs of interest with placebo, no DMARDs, or other DMARDs. The outcome was incident ILD. We summarized the literature on DMARDs and incident RA-ILD risk. Among studies with sufficient quality, we performed meta-analyses to obtain odds ratios (OR) and 95 % confidence intervals (95 %CI) using the Mantel-Haenszel method.

Results

Among 3,612 studies, we identified a total of 40 papers that encompassed 486,465 patients with RA and 3,928 incident ILD outcomes that were included in the final systematic review and meta-analysis. Among the studies, 24 were RCTs, 4 were prospective cohort studies, 9 were retrospective cohort studies, 2 were case-control studies, and 1 was a post-marketing surveillance study. The pooled analysis from RCTs revealed no statistically significant difference in the odds of ILD development for any specific DMARD across all comparisons examined. The largest identified RCT (Oral Surveillance trial) of tofacitinib (n = 2,911) vs. tumor necrosis factor inhibitor (TNFi, n = 1,451) found no relationship with incident ILD (OR 0.94, 95 %CI 0.52 to 1.69, p = 0.828). In 7 observational studies, the use of methotrexate (MTX) yielded a pooled OR for ILD of 0.49 (95 %CI 0.32 to 0.76, p < 0.001) compared to those not using MTX. In a single observational study, tofacitinib users had an OR for ILD of 0.36 (95 %CI 0.15 to 0.87, p = 0.024) compared to TNFi users.

Conclusion

Observational data suggest no increased risk for any DMARD for incident RA-ILD risk, and perhaps a potential protective role of MTX and tofacitinib. However, these studies may be susceptible to bias, and no specific DMARD showed associations with incident RA-ILD in RCTs. Further well-designed prospective studies are warranted for definitive conclusions on the potential relationship between DMARDs and RA-ILD risk.

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.