Chen Yuehong, Liu Huan, Huang Yupeng, Lin Sang, Yin Geng, Xie Qibing
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
Front Pharmacol. 2021 Jul 19;12:632551. doi: 10.3389/fphar.2021.632551. eCollection 2021.
This systematic review and meta-analysis is aimed at assessing the risks of cardiovascular adverse events in patients with rheumatoid arthritis (RA) who have been treated with fostamatinib. The electronic databases of OVID Medline, OVID EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched to identify studies that reported cardiovascular events or hypertension in RA patients treated with fostamatinib. Two reviewers separately and simultaneously screened the retrieved studies based on study selection criteria, collected data and performed methodological quality assessments. The effect size of meta-analysis was estimated by the Peto odds ratio (OR) or relative risk (RR) with 95% confidence intervals (95%CI). Funnel plot was used to estimate publication bias and sensitivity analysis was performed to test the robustness of the results. A total of 12 trials composed of 5,618 participants with low to moderate risk of bias were included. In comparison to the placebo, the use of fostamatinib was found to elevate the risk of hypertension (RR=3.82, 95%CI 2.88-5.05) but was not associated with the risks of all-cause death (Peto OR=0.16, 95%CI 0.02-1.24), major adverse cardiovascular events (Peto OR=1.24, 95%CI 0.26-5.97), pulmonary heart disease and disease of pulmonary circulation (Peto OR=1.23, 95%CI 0.13-11.87), in addition to other forms of heart disease (Peto OR=1.96, 95%CI 0.72-5.38). Furthermore, sensitivity analysis showed no significant change in effective trends and no publication bias was found. Fostamatinib is associated with increased risk of hypertension; however, no increased risks of cardiovascular events were observed. Further well-planned cohort studies with large study populations and longer follow-up times are needed to elucidate the outcomes. : [PROSPERO], identifier [CRD42020198217].
本系统评价和荟萃分析旨在评估接受 fostamatinib 治疗的类风湿关节炎（RA）患者发生心血管不良事件的风险。检索了 OVID 医学数据库、OVID 循证医学数据库、Cochrane 对照试验中心注册库和科学网等电子数据库，以识别报告接受 fostamatinib 治疗的 RA 患者心血管事件或高血压的研究。两名评价者根据研究选择标准分别同时筛选检索到的研究，收集数据并进行方法学质量评估。荟萃分析的效应量采用 Peto 比值比（OR）或相对风险（RR）及 95%置信区间（95%CI）进行估计。采用漏斗图评估发表偏倚，并进行敏感性分析以检验结果的稳健性。共纳入 12 项试验，5618 名参与者，偏倚风险低至中度。与安慰剂相比，发现使用 fostamatinib 会增加高血压风险（RR = 3.82，95%CI 2.88 - 5.05），但与全因死亡风险（Peto OR = 0.16，95%CI 0.02 -
1.24）、主要心血管不良事件（Peto OR = 1.24，95%CI 0.26 - 5.97）、肺心病和肺循环疾病（Peto OR = 1.23，95%CI 0.13 - 11.87）以及其他形式的心脏病（Peto OR = 1.96，95%CI 0.72 - 5.38）无关。此外，敏感性分析显示效应趋势无显著变化，未发现发表偏倚。Fostamatinib 与高血压风险增加相关；然而，未观察到心血管事件风险增加。需要进一步开展设计良好、研究人群规模大且随访时间长的队列研究以阐明结局。：[国际前瞻性系统评价注册库（PROSPERO）]，标识符[CRD42020198217]
