Wang Zhao, Bao Hong-Wei, Ji Yong
Department of Orthopaedics.
Department of General Surgery, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City 214500, Jiangsu Province, China.
Medicine (Baltimore). 2020 Feb;99(8):e19193. doi: 10.1097/MD.0000000000019193.
This meta-analysis aimed to explore the efficacy and safety of rituximab combined with methotrexate (MTX) versus MTX alone in the treatment of rheumatoid arthritis (RA).
We performed an electronic search of PubMed (1950-January 2018), EMBASE (1974-January 2018), the Cochrane Library (January 2018 Issue 3), the Google database (1950-January 2018), and the Chinese Wanfang database (1950-January 2018). Only randomized controlled trials (RCTs) were included. The American College of Rheumatology 20% improvement criteria (ACR20), ACR50, ACR70, total complication rate, and infection rate were the outcomes. A fixed/random effects model was used according to the heterogeneity assessed by the I statistic. Data analysis was performed using Stata 12.0 software.
A total of five RCTs with 3299 patients (rituximab combined with MTX group = 1787, MTX only group = 1512) were included in the meta-analysis. The pooled risk ratio showed that the administration of rituximab combined with MTX was associated with more ACR20, ACR50, and ACR70 than the administration of MTX only (P < .05). There were no significant differences between the two groups in terms of the total complication rate and the infection rate (P > .05).
The administration of rituximab combined with MTX was effective and safe for RA patients. Additional high-quality RCTs with long-term follow-ups should be conducted in the future to identify the potential complications in the long term.
本荟萃分析旨在探讨利妥昔单抗联合甲氨蝶呤（MTX）与单用MTX治疗类风湿关节炎（RA）的疗效和安全性。
我们对PubMed（1950年至2018年1月）、EMBASE（1974年至2018年1月）、Cochrane图书馆（2018年第3期）、谷歌数据库（1950年至2018年1月）和中国万方数据库（1950年至2018年1月）进行了电子检索。仅纳入随机对照试验（RCT）。美国风湿病学会20%改善标准（ACR20）、ACR50、ACR70、总并发症发生率和感染率为观察指标。根据I统计量评估的异质性采用固定/随机效应模型。使用Stata 12.0软件进行数据分析。
本荟萃分析共纳入5项RCT，涉及3299例患者（利妥昔单抗联合MTX组 = 1787例，单用MTX组 = 1512例）。合并风险比显示，与单用MTX相比，利妥昔单抗联合MTX治疗的ACR20、ACR50和ACR70更高（P < 0.05）。两组在总并发症发生率和感染率方面无显著差异（P > 0.05）。
利妥昔单抗联合MTX治疗RA患者有效且安全。未来应开展更多长期随访的高质量RCT，以明确长期潜在并发症。
