Tornero Molina Jesús, Hernández-Cruz Blanca, Corominas Héctor
Departamento de Reumatología, Hospital de Guadalajara, 19002 Guadalajara, Spain.
Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28805 Madrid, Spain.
J Clin Med. 2023 Dec 21;13(1):48. doi: 10.3390/jcm13010048.
We aimed to analyse the effectiveness, efficiency, and safety of initial treatment with biological therapies in rheumatoid arthritis (RA).
Qualitative study. A group of RA experts was selected. A scoping review in Medline was conducted to analyse the evidence of initial RA treatment with biological therapies. Randomised clinical trials were selected. Two reviewers analysed the articles and compiled the data, whose quality was assessed using the Jadad scale. The experts discussed the review's findings and generated a series of general principles: Results: Seventeen studies were included. Most of the included patients were middle-aged women with early RA (1-7 months) and multiple poor prognostic factors. Initial treatment with TNF-alpha inhibitors combined with methotrexate (MTX) and an IL6R inhibitor (either in mono or combination therapy) is effective (activity, function, radiographic damage, quality of life), safe, and superior to MTX monotherapy in the short and medium term. In the long term, patients who received initial treatment with biologicals presented better results than those whose initial therapy was with MTX.
Initial treatment of RA with biological therapies is effective, efficient, and safe in the short, medium, and long term, particularly for patients with poor prognostic factors.
我们旨在分析类风湿关节炎（RA）初始生物治疗的有效性、效率和安全性。
定性研究。挑选了一组RA专家。在Medline上进行了一项范围综述，以分析生物疗法用于RA初始治疗的证据。选取了随机临床试验。两名评审员分析文章并汇总数据，使用Jadad量表评估数据质量。专家们讨论了综述结果并制定了一系列一般原则。
纳入了17项研究。纳入的大多数患者为患有早期RA（1 - 7个月）且有多个不良预后因素的中年女性。初始使用肿瘤坏死因子-α抑制剂联合甲氨蝶呤（MTX）以及白细胞介素6受体抑制剂（单药或联合治疗）进行治疗是有效的（在活动度、功能、影像学损伤、生活质量方面）、安全的，且在短期和中期优于MTX单药治疗。从长期来看，初始接受生物制剂治疗的患者比初始接受MTX治疗的患者效果更好。
生物疗法用于RA的初始治疗在短期、中期和长期都是有效、高效且安全的，尤其对于有不良预后因素的患者。
