Service de Rhumatologie, Hôpital Bicetre, 78 avenue du Général Leclerc, 94275 Le Kremlin Bicetre, France.
Ann Rheum Dis. 2010 Jun;69(6):1022-8. doi: 10.1136/ard.2009.117622. Epub 2009 Dec 4.
There is a need for biomarkers that can predict anti-tumour necrosis factor (anti-TNF) treatment outcome in patients with rheumatoid arthritis (RA). Several studies have suggested that the rare A allele of the tumour necrosis factor alpha (TNFA) -308G-->A polymorphism could be associated with a poorer response to anti-TNF therapy. Nevertheless, these results remain controversial.
To determine by a meta-analysis whether the TNFA -308G-->A polymorphism is associated with response to anti-TNF treatment in patients with RA.
A bibliographic search identified studies in which the TNFA -308G-->A gene polymorphism was investigated in Caucasian patients with RA treated with anti-TNF agents. Complementary data were requested when the 28-joint count Disease Activity Score (DAS28) was not used as the primary outcome measure. Odds ratios (ORs) for response based on DAS28 and standardised mean difference (SMD) for mean improvement of DAS28 were calculated to assess the potential association between TNFA -308 genotypes and response to anti-TNF agents.
The bibliographic search yielded 12 studies that met the inclusion criteria, which were supplemented with the data from a large Dutch cohort (n=426). The OR based on the 12 studies including 1721 patients was 1.24 (95% CI 0.98 to 1.56) and the SMD based on 11 studies including 2579 patients was -0.18 (95% CI -0.36 to 0.1). Subgroup analysis based on the two classes of anti-TNF agents did not demonstrate any association between TNFA -308 genotypes and anti-TNF treatment outcome.
According to this meta-analysis, the TNFA -308 polymorphism is not a predictor of the clinical response to anti-TNF treatment in RA.
需要有生物标志物可以预测类风湿关节炎（RA）患者的抗肿瘤坏死因子（抗 TNF）治疗效果。几项研究表明，肿瘤坏死因子α（TNFα）-308G-->A 多态性的罕见 A 等位基因可能与抗 TNF 治疗反应较差相关。然而，这些结果仍存在争议。
通过荟萃分析确定 TNFα-308G-->A 多态性是否与 RA 患者对抗 TNF 治疗的反应相关。
通过文献检索确定了研究 TNFα-308G-->A 基因多态性与接受抗 TNF 药物治疗的白种人 RA 患者反应的研究。当 28 关节疾病活动度评分（DAS28）未作为主要结局测量时，请求补充数据。根据 DAS28 计算反应的优势比（OR）和 DAS28 均值改善的标准化均数差（SMD）来评估 TNFα-308 基因型与抗 TNF 药物反应之间的潜在关联。
文献检索产生了 12 项符合纳入标准的研究，并补充了来自荷兰大型队列（n=426）的数据。包括 1721 名患者的 12 项研究的 OR 为 1.24（95%CI 0.98 至 1.56），包括 2579 名患者的 11 项研究的 SMD 为-0.18（95%CI -0.36 至 0.1）。基于两类抗 TNF 药物的亚组分析并未显示 TNFα-308 基因型与抗 TNF 治疗结果之间存在任何关联。
根据这项荟萃分析，TNFα-308 多态性不是 RA 患者对抗 TNF 治疗临床反应的预测因子。
