Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou.
Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Rheumatology (Oxford). 2020 Nov 1;59(11):3172-3180. doi: 10.1093/rheumatology/keaa313.
To determine the efficacy of biologics in preventing radiographic progression in peripheral joints of PsA patients.
Studies were searched in MEDLINE, Web of Science, and abstracts from the last three EULAR and ACR meetings up to 31 December 2019. Primary and secondary endpoints were the proportion of patients without radiographic progression and the mean change in total radiographic score at week 24.
Eleven studies, involving 5382 patients, 9 drugs and 18 treatments, were included. Patients receiving biologics were more likely to achieve radiographic non-progression compared with placebo [odds ratio: pooled: 2.40, 95% CI: 2.00, 2.87; TNF inhibitors (TNFi): 2.94, 95% CI: 2.38, 3.63; IL inhibitors (ILi): 2.15, 95% CI: 1.69, 2.74; abatacept: 1.54, 95% CI: 1.03, 2.28] and have significantly lower radiographic progression [standardized mean difference (SMD): pooled: -2.16, 95% CI: -2.91, -1.41; TNFi: -2.82, 95% CI: -4.31, -1.33; ILi: -1.60, 95% CI: -2.49, -0.72; abatacept: -0.40, 95% CI: -0.59, -0.21]. Concomitant MTX therapy was not superior to monotherapy (SMD: pooled: 0.01, 95% CI: -0.07, 0.08; biologics: 0.01, 95% CI: -0.09, 0.11; placebo: -0.01, 95% CI: -0.13, 0.12). The effect of ustekinumab and secukinumab on radiographic progression was not influenced by prior anti-TNF therapy (SMD: -0.08, 95% CI: -0.25, 0.10).
Biologic agents may retard radiographic progression in PsA patients in terms of bone erosion and joint space narrowing compared with placebo. MTX seems to have no added effect. Prior anti-TNF therapy seems to not influence the radiographic efficacy of IL blockers.
确定生物制剂在预防银屑病关节炎患者外周关节放射学进展中的疗效。
检索 MEDLINE、Web of Science 以及最近三次 EULAR 和 ACR 会议的摘要，检索时间截至 2019 年 12 月 31 日。主要和次要终点分别为无放射学进展的患者比例和第 24 周时总放射评分的平均变化。
纳入 11 项研究，涉及 5382 例患者、9 种药物和 18 种治疗方法。与安慰剂相比，接受生物制剂治疗的患者更有可能实现放射学非进展[优势比：汇总：2.40，95%置信区间：2.00，2.87；肿瘤坏死因子抑制剂（TNFi）：2.94，95%置信区间：2.38，3.63；白细胞介素抑制剂（ILi）：2.15，95%置信区间：1.69，2.74；阿巴西普：1.54，95%置信区间：1.03，2.28]，且放射学进展明显更低[标准化均数差（SMD）：汇总：-2.16，95%置信区间：-2.91，-1.41；TNFi：-2.82，95%置信区间：-4.31，-1.33；ILi：-1.60，95%置信区间：-2.49，-0.72；阿巴西普：-0.40，95%置信区间：-0.59，-0.21]。同时使用 MTX 治疗并不优于单药治疗（SMD：汇总：0.01，95%置信区间：-0.07，0.08；生物制剂：0.01，95%置信区间：-0.09，0.11；安慰剂：-0.01，95%置信区间：-0.13，0.12）。乌司奴单抗和司库奇尤单抗对放射学进展的影响不受先前抗 TNF 治疗的影响（SMD：-0.08，95%置信区间：-0.25，0.10）。
与安慰剂相比，生物制剂可能会减缓银屑病关节炎患者的放射学进展，包括骨侵蚀和关节间隙变窄。MTX 似乎没有额外的效果。先前的抗 TNF 治疗似乎不会影响白细胞介素抑制剂的放射学疗效。
