Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Endocrinology and Rheumatology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong District, Shanghai, China.
Department of Orthopaedics, ShangHai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
Semin Arthritis Rheum. 2022 Aug;55:152031. doi: 10.1016/j.semarthrit.2022.152031. Epub 2022 May 30.
Rheumatoid arthritis(RA) sufferers have a higher mortality risk than the healthy population, and methotrexate (MTX) as a base drug for RA treatment is believed to affect patients mortality. Systematic analyses of MTX and RA mortality are lacking and it is still confused about the role of MTX on the long-term prognosis of RA.
We performed a systematic review and meta-analysis to identify any influence of MTX on mortality among RA patients. Hazard ratio(HR) for all-cause mortality were pooled in a meta-analysis, and HR for mortality from RA with cardiovascular diseases (RA-CVD) and mortality from RA associated interstitial lung diseases (RA-ILD) were also pooled and analyzed.
Fifteen studies were eventually included. Meta-analysis of data from 15 studies on overall mortality showed that MTX significantly reduced mortality in patients with RA (HR = 0.59, 95%CI 0.50-0.71, P < 0.001), MTX was independently associated with decreased RA-CVD-induced mortality (HR = 0.72, 95%CI 0.53-0.97, P = 0.031). In the meanwhile, MTX was also significantly reduced mortality in RA-ILD (HR = 0.44, 95%CI 0.20-0.95, P = 0.037).
MTX can significantly decrease the overall mortality for RA patients, specifically, RA-CVD- and RA-ILD-induced mortality were reduced.
类风湿关节炎（RA）患者的死亡率高于健康人群，甲氨蝶呤（MTX）作为 RA 治疗的基础药物，据信会影响患者的死亡率。缺乏对 MTX 和 RA 死亡率的系统分析，对于 MTX 对 RA 长期预后的作用仍存在混淆。
我们进行了系统评价和荟萃分析，以确定 MTX 是否会对 RA 患者的死亡率产生影响。采用荟萃分析汇总全因死亡率的风险比（HR），并汇总和分析 RA 合并心血管疾病（RA-CVD）和 RA 相关性间质性肺疾病（RA-ILD）死亡率的 HR。
最终纳入了 15 项研究。对 15 项关于总体死亡率的研究数据进行荟萃分析表明，MTX 显著降低了 RA 患者的死亡率（HR=0.59，95%CI 0.50-0.71，P<0.001），MTX 与降低 RA-CVD 引起的死亡率独立相关（HR=0.72，95%CI 0.53-0.97，P=0.031）。同时，MTX 也显著降低了 RA-ILD 相关的死亡率（HR=0.44，95%CI 0.20-0.95，P=0.037）。
MTX 可显著降低 RA 患者的总体死亡率，特别是降低了 RA-CVD 和 RA-ILD 引起的死亡率。
