Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou 412000, China.
Int J Clin Pract. 2022 Jul 21;2022:5684293. doi: 10.1155/2022/5684293. eCollection 2022.
Influence of iguratimod on bone mineral density (BMD) and biomarkers of bone metabolism in patients with rheumatoid arthritis (RA) remains not determined. Accordingly, a meta-analysis was performed for systematical evaluation.
Relevant randomized controlled trials (RCTs) were retrieved by searching of PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases. A random-effect model was used to pool the results.
In total, 24 RCTs including 2439 patients with RA contributed to the meta-analysis. Pooled results showed that compared to methotrexate alone, additional use of iguratimod 25 mg Bid for 12∼24 weeks significantly improved lumbar-spine BMD (mean difference [MD]: 0.12, 95% confidence interval [CI]: 0.04 to 0.20, =0.002, = 39%) in patients with RA. Moreover, treatment with iguratimod was associated with increased serum osteoprotegerin (MD: 180.36 pg/ml, 95% CI: 122.52 to 238.20, < 0.001, = 48%), and decreased serum receptor activator for nuclear factor kappa-B ligand (MD: -10.65 pmol/l, 95% CI: -15.59 to -5.72, < 0.001, = 53%). In addition, iguratimod was associated with increased bone formation markers such as the serum N-terminal middle molecular fragment of osteocalcin (MD: 4.23 ng/ml, 95% CI: 3.74 to 4.71, < 0.001, = 35%) and total procollagen type I amino-terminal propeptide (MD: 9.10 ng/ml, 95% CI: 7.39 to 10.80, < 0.001, = 86%), but decreased the bone resorption marker such as serum -C terminal cross-linking telopeptide of type 1 collagen (MD: -0.18 pg/ml, 95% CI: -0.21 to -0.14, < 0.001, = 70%).
Iguratimod could prevent the bone loss and improve the bone metabolism in patients with RA.
来氟米特对类风湿关节炎（RA）患者的骨密度（BMD）和骨代谢生物标志物的影响尚不确定。因此，进行了荟萃分析以进行系统评估。
通过检索 PubMed、Embase、Cochrane 图书馆、中国知网（CNKI）和万方数据库，检索相关的随机对照试验（RCT）。采用随机效应模型对结果进行合并。
共有 24 项 RCT 纳入了 2439 例 RA 患者，参与了本次荟萃分析。汇总结果表明，与单独使用甲氨蝶呤相比，在 12∼24 周内加用 25mg 依那西普 bid 治疗可显著改善 RA 患者的腰椎 BMD（平均差异[MD]：0.12，95%置信区间[CI]：0.04 至 0.20，=0.002，=39%）。此外，依那西普治疗与血清护骨素（MD：180.36pg/ml，95%CI：122.52 至 238.20， < 0.001，=48%）的升高和血清核因子κB 受体激活物配体（MD：-10.65pmol/L，95%CI：-15.59 至-5.72， < 0.001，=53%）的降低相关。此外，依那西普还与血清 N 端中分子片段骨钙素（MD：4.23ng/ml，95%CI：3.74 至 4.71， < 0.001，=35%）和总 I 型前胶原氨基端前肽（MD：9.10ng/ml，95%CI：7.39 至 10.80， < 0.001，=86%）等骨形成标志物的升高相关，但与血清 I 型胶原 C 端交联肽（MD：-0.18pg/ml，95%CI：-0.21 至-0.14， < 0.001，=70%）等骨吸收标志物的降低相关。
依那西普可预防 RA 患者的骨丢失并改善其骨代谢。
