Lemos Lívia Lovato Pires, de Oliveira Costa Juliana, Almeida Alessandra Maciel, Junior Haliton Oliveira, Barbosa Mariana Michel, Kakehasi Adriana Maria, Acurcio Francisco Assis
Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, bloco 2, 1º andar, sala 1023, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil,
Rheumatol Int. 2014 Oct;34(10):1345-60. doi: 10.1007/s00296-014-3006-2. Epub 2014 Apr 13.
We did a systematic review and meta-analysis on the efficacy and safety of the anti-TNF drugs adalimumab, etanercept, golimumab and infliximab used in psoriatic arthritis (PsA) adult treatment. Additionally, we present results of anti-TNF use in real life settings. We searched Embase, Medline, Cochrane Central and LILACS, from inception to 11/08/2013, for studies comparing anti-TNFs with each other or with controls. We included nine randomized controlled trials and six observational studies. ACR20, ACR50, PsARC and PASI75 responses were achieved by more users of anti-TNF than control after up to 24 weeks of treatment. More participants who used etanercept and infliximab achieved ACR70. After all patients originally randomized to anti-TNF or placebo had used anti-TNF for at least 24 weeks, we observed difference only with regard to ACR70 response. Radiographic end points were achieved by more patients in anti-TNF group, and they seem to be time dependent-the longer patients use the drug the better the results. Etanercept and infliximab had worse results on application site reactions, but in general anti-TNF drugs in the regimens studied were as safe as control/placebo. There seems to be no difference in efficacy and effectiveness among anti-TNFs, but superiority head-to-head studies are still needed. Meanwhile, other factors should be taken into account in the choice of medication, such as costs and patient convenience.
我们对用于银屑病关节炎（PsA）成人治疗的抗TNF药物阿达木单抗、依那西普、戈利木单抗和英夫利昔单抗的疗效和安全性进行了系统评价和荟萃分析。此外，我们还展示了抗TNF药物在实际应用中的结果。我们检索了Embase、Medline、Cochrane Central和LILACS数据库，检索时间从建库至2013年8月11日，以查找比较抗TNF药物之间或与对照药物的研究。我们纳入了9项随机对照试验和6项观察性研究。在长达24周的治疗后，使用抗TNF药物的患者比对照组更多地实现了美国风湿病学会（ACR）20、ACR50、银屑病关节炎应答标准（PsARC）和银屑病面积和严重程度指数改善75%（PASI75）的反应。更多使用依那西普和英夫利昔单抗的参与者实现了ACR70。在所有最初随机分配接受抗TNF药物或安慰剂治疗的患者使用抗TNF药物至少24周后，我们仅观察到ACR70反应方面的差异。抗TNF药物组更多患者达到了影像学终点，而且这些似乎与时间相关——患者使用药物时间越长，结果越好。依那西普和英夫利昔单抗在注射部位反应方面结果较差，但总体而言，所研究方案中的抗TNF药物与对照/安慰剂一样安全。抗TNF药物之间在疗效和有效性方面似乎没有差异，但仍需要进行直接比较的优效性研究。同时，在选择药物时应考虑其他因素，如成本和患者便利性。
