Second Department of Rheumatology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi District, Shenyang, 110072, Liaoning, China.
Intensive Care Unit, The People's Hospital of Liaoning Province, NO. 33 Wenyi Road, Shenhe District, Shenyang, 110016, Liaoning, China.
Clin Rheumatol. 2019 Oct;38(10):2747-2756. doi: 10.1007/s10067-019-04608-z. Epub 2019 Jun 4.
To evaluate the efficacy and safety of interleukin 17 (IL-17) inhibitors in two rheumatoid arthritis (RA) populations: biologic-naïve or tumor necrosis factor inhibitor inadequate responders (TNF-IR).
A systematic search was performed in major electronic databases to identify relevant randomized controlled trials (RCTs) reporting the American College of Rheumatology 20% (ACR20), ACR50, ACR70 responses and adverse events (AEs) of IL-17 inhibitors versus placebo in patients with RA. We divided these patients into two subgroups: biologic-naïve or TNF-IR. The meta-analysis was performed using Review Manager 5.3 software. Results were expressed as risk ratio (RR) with pertinent 95% confidence interval (95% CI).
Ten studies with a total of 2499 patients were included. For biologic-naïve patients, ACR50 and ACR70 responses were significantly better with IL-17 inhibitors than placebo (RR = 1.71, 95% CI 1.23-2.38, P = 0.001 and RR = 2.63, 95% CI 1.10-6.25, P = 0.03, respectively), but ACR20 responses for IL-17 inhibitors were not statistically superior to placebo (RR = 1.34, 95% CI 0.94-1.91, P = 0.11). For TNF-IR, IL-17 inhibitors were effective in achieving ACR20 (RR = 1.67, 95% CI 1.40-2.00, P < 0.00001), ACR50 (RR = 1.94, 95% CI 1.43-2.63, P < 0.0001), and ACR70 (RR = 2.11, 95% CI 1.26-3.55, P = 0.005) compared to placebo. In the safety analysis, IL-17 inhibitors did not show increased risk of any AEs by comparing to placebo in both biologic-naïve patients and TNF-IR.
IL-17 inhibitors were effective in the treatment of RA without increased risk of AEs, whether for biologic-naïve patients or TNF-IR. Key Points • In this meta-analysis comparing IL-17 inhibitors with placebo in 2499 rheumatoid arthritis patients, IL-17 inhibitors improved ACR50 and ACR70, but not ACR20, responses in biologic-naïve patients. • IL-17 inhibitors improved ACR20, ACR50, and ACR70 responses in tumor necrosis factor inhibitor inadequate responders.
评估白细胞介素 17（IL-17）抑制剂在两种类风湿关节炎（RA）人群中的疗效和安全性：生物制剂初治或肿瘤坏死因子抑制剂应答不足（TNF-IR）。
在主要电子数据库中进行系统检索，以确定报告白细胞介素 17 抑制剂与安慰剂相比在 RA 患者中美国风湿病学会 20%（ACR20）、ACR50、ACR70 反应和不良事件（AE）的相关随机对照试验（RCT）。我们将这些患者分为两个亚组：生物制剂初治或 TNF-IR。使用 Review Manager 5.3 软件进行荟萃分析。结果表示为风险比（RR）及其相关 95%置信区间（95%CI）。
纳入了 10 项共 2499 名患者的研究。对于生物制剂初治患者，白细胞介素 17 抑制剂的 ACR50 和 ACR70 反应明显优于安慰剂（RR=1.71，95%CI 1.23-2.38，P=0.001 和 RR=2.63，95%CI 1.10-6.25，P=0.03），但白细胞介素 17 抑制剂的 ACR20 反应并不优于安慰剂（RR=1.34，95%CI 0.94-1.91，P=0.11）。对于 TNF-IR，白细胞介素 17 抑制剂在实现 ACR20（RR=1.67，95%CI 1.40-2.00，P<0.00001）、ACR50（RR=1.94，95%CI 1.43-2.63，P<0.0001）和 ACR70（RR=2.11，95%CI 1.26-3.55，P=0.005）方面优于安慰剂。在安全性分析中，与安慰剂相比，白细胞介素 17 抑制剂在生物制剂初治患者和 TNF-IR 中均未显示出增加任何 AE 的风险。
白细胞介素 17 抑制剂在治疗 RA 方面有效，且不增加 AE 风险，无论患者是否为生物制剂初治或 TNF-IR。
·在比较白细胞介素 17 抑制剂与安慰剂在 2499 例类风湿关节炎患者中的疗效的这项荟萃分析中，白细胞介素 17 抑制剂改善了生物制剂初治患者的 ACR50 和 ACR70，但未改善 ACR20。
·白细胞介素 17 抑制剂改善了肿瘤坏死因子抑制剂应答不足患者的 ACR20、ACR50 和 ACR70 反应。
