Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain.
Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain.
Joint Bone Spine. 2014 Jan;81(1):41-50. doi: 10.1016/j.jbspin.2013.04.004. Epub 2013 Jun 2.
To systematically analyze literature with the aim of examining whether rheumatoid factor (RF) is a predictor of response to tumor necrosis factor (TNF) antagonists in rheumatoid arthritis (RA).
A systematic review and meta-analysis of observational studies were conducted. All studies on the association of baseline RF (titer and/or status) and response to any TNF antagonists, or with enough information to estimate this association were included. Qualitative analysis and meta-analysis using random-effects approach by type of outcome response and RF test was performed. Risk of publication bias was also evaluated.
The systematic review included 18 studies of 4163 identified articles, involving 5703 patients with homogeneous baseline characteristics. The most common outcome to assess response was European League Against Rheumatism (EULAR) response criteria, normally merging good and moderate categories as response. The weighted mean difference (WMD) of baseline IgM RF titer in meta-analysis was higher in the non-responders group [-101.58 (95% CI -156.58,-46.59) I2=0.0]. Combined odds ratios (ORs) of positive IgM RF, positive IgA RF, and positive IgG RF to achieve good/moderate response were 1.08 (0.80, 1.47), I2=40.9%; 0.83 (0.39, 1.73), I2=39.8%, and 1.30 (0.48, 3.51), I2=62.9%, respectively. We did not find an association between a positive IgM RF and EULAR good response or remission.
This meta-analysis does not support baseline IgM RF titer as a predictor of response to TNF antagonists in RA. However, this conclusion is hampered by high heterogeneity in the studies included in this meta-analysis.
系统分析文献，以评估类风湿因子（RF）是否可预测类风湿关节炎（RA）患者对肿瘤坏死因子（TNF）拮抗剂的反应。
进行了系统评价和观察性研究的荟萃分析。纳入了所有关于基线 RF（滴度和/或状态）与任何 TNF 拮抗剂反应相关的研究，或包含足够信息以估计该相关性的研究。通过结局反应和 RF 检测类型的随机效应方法进行定性分析和荟萃分析。还评估了发表偏倚的风险。
系统评价纳入了 18 项研究，涉及 4163 篇文章，共 5703 例基线特征相似的患者。最常见的评估反应的结局是欧洲抗风湿病联盟（EULAR）反应标准，通常将良好和中度类别合并为反应。荟萃分析中，非应答者组的基线 IgM RF 滴度的加权均数差值（WMD）更高[-101.58（95%CI-156.58，-46.59）I²=0.0]。阳性 IgM RF、阳性 IgA RF 和阳性 IgG RF 获得良好/中度反应的合并优势比（OR）分别为 1.08（0.80，1.47），I²=40.9%；0.83（0.39，1.73），I²=39.8%和 1.30（0.48，3.51），I²=62.9%。我们未发现阳性 IgM RF 与 EULAR 良好反应或缓解之间存在关联。
本荟萃分析不支持基线 IgM RF 滴度可预测 RA 患者对 TNF 拮抗剂的反应。然而，由于纳入本荟萃分析的研究存在高度异质性，这一结论受到了阻碍。
