Ibrahim Ammar, Ahmed Mohammed, Conway Richard, Carey John J
Department of Medicine, National University of Ireland Galway, Galway, Ireland.
Department of Rheumatic Diseases, St. James's University Hospital, Dublin, Ireland.
J Clin Med. 2018 Dec 21;8(1):15. doi: 10.3390/jcm8010015.
The aim of this study was to determine the risk of infection in adults with inflammatory rheumatic diseases (IRDs) treated with methotrexate. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing methotrexate versus placebo in adults using MEDLINE, EMBASE, and CENTRAL databases from 1980 to August 2017. The primary outcome was the risk of infection associated with methotrexate therapy. We chose a random effect model to summarize adverse event outcomes as risk ratios (RRs) and related 95% confidence intervals (95% CI). Twelve RCTs (total patients 1146) met the inclusion criteria for our main analysis, and ten for risk of serious infection (total patients 906). Overall, methotrexate was associated with increased risk of infection in rheumatoid arthritis (RA) (RR: 1.25; 95% CI, 1.01⁻1.56; p = 0.04; I² = 0%), but not in other non-RA IRD populations. There was no increased risk of total infections (RR: 1.14; 95% CI, 0.98⁻1.34; p = 0.10; I² = 0%) or serious infections (RR: 0.76; 95% CI, 0.11⁻5.15; p = 0.78; I² = 0%) in all included IRDs. Conclusively, methotrexate use in IRDs is associated with a higher risk of all infections in RA, but not in other non-RA (IRD) populations. There is no increased risk of serious infections.
本研究的目的是确定接受甲氨蝶呤治疗的成人炎症性风湿性疾病（IRDs）患者的感染风险。我们使用MEDLINE、EMBASE和CENTRAL数据库，对1980年至2017年8月期间评估甲氨蝶呤与安慰剂治疗成人患者的随机对照试验（RCTs）进行了系统评价和荟萃分析。主要结局是与甲氨蝶呤治疗相关的感染风险。我们选择随机效应模型，将不良事件结局总结为风险比（RRs）和相关的95%置信区间（95%CI）。12项RCTs（共1146例患者）符合我们主要分析的纳入标准，10项符合严重感染风险分析的纳入标准（共906例患者）。总体而言，甲氨蝶呤与类风湿关节炎（RA）患者感染风险增加相关（RR：1.25；95%CI，1.01⁻1.56；p = 0.04；I² = 0%），但在其他非RA的IRDs人群中并非如此。在所有纳入的IRDs患者中，总体感染风险（RR：1.14；95%CI，0.98⁻1.34；p = 0.10；I² = 0%）或严重感染风险（RR：0.76；95%CI，0.11⁻5.15；p = 0.78；I² = 0%）均未增加。总之，在IRDs中使用甲氨蝶呤与RA患者所有感染风险较高相关，但在其他非RA（IRD）人群中并非如此。严重感染风险没有增加。
