Internal Medicine Department, College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia.
Medicina (Kaunas). 2024 Jul 17;60(7):1156. doi: 10.3390/medicina60071156.
Anti-tumor necrosis factor-alpha (TNF-α) agents are effective in treating rheumatoid arthritis (RA) but may entail a risk of lymphoma due to TNF-α's role in immune surveillance. This systematic review and meta-analysis assesses the risk of lymphoma in patients with RA treated with anti-TNF agents versus patients treated with methotrexate and/or a placebo. The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, PubMed, and Google Scholar were systematically searched for relevant literature. Data were extracted and analyzed to determine risk ratios (RRs) and 95% confidence intervals (CIs), with heterogeneity assessed using I statistics. Methodological quality and risk of bias were assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale for observational studies. The search yielded 932 articles, 13 of which were retained for qualitative review and 12 for quantitative synthesis. Overall, the studies reviewed included 181,735 participants: 3772 from six RCTs and 177,963 from seven observational studies. The meta-analysis of RCTs revealed no significant difference in the risk of lymphoma between patients receiving anti-TNF-α therapy and patients on conventional treatments, with an overall RR of 1.43 (95% CI: 0.32-5.16) and I of 0%. Conversely, observational studies showed some variability, with an overall RR of 1.43 (95% CI: 0.59-3.47) and significant heterogeneity (I = 95%), whereas others indicated a potentially elevated risk of lymphoma in specific subgroups but had inconsistent results. The systematic and meta-analysis revealed no significant difference in the risk of lymphoma for patients with RA treated with anti-TNF-α agents versus conventional therapies. However, given the limitations of the studies included, additional research is needed to validate the results and explore potential risk factors contributing to the development of lymphoma in patients with RA.
抗肿瘤坏死因子-α（TNF-α）药物在治疗类风湿关节炎（RA）方面有效，但由于 TNF-α在免疫监视中的作用，可能存在淋巴瘤的风险。本系统评价和荟萃分析评估了接受抗 TNF 药物治疗的 RA 患者与接受甲氨蝶呤和/或安慰剂治疗的患者相比，发生淋巴瘤的风险。系统检索了 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、Embase、PubMed 和 Google Scholar 以获取相关文献。提取和分析数据以确定风险比（RR）和 95%置信区间（CI），并使用 I 统计量评估异质性。使用 Cochrane 随机对照试验（RCT）风险偏倚工具和 Newcastle-Ottawa 量表评估观察性研究的方法学质量和偏倚风险。检索结果产生了 932 篇文章，其中 13 篇用于定性综述，12 篇用于定量综合。总体而言，综述中包括的研究共纳入了 181735 名参与者：6 项 RCT 中有 3772 名参与者，7 项观察性研究中有 177963 名参与者。RCT 的荟萃分析显示，接受抗 TNF-α 治疗的患者与接受常规治疗的患者之间，淋巴瘤的风险无显著差异，总体 RR 为 1.43（95%CI：0.32-5.16），I²为 0%。相反，观察性研究显示存在一定的变异性，总体 RR 为 1.43（95%CI：0.59-3.47），且存在显著异质性（I = 95%），而其他研究则表明在特定亚组中存在潜在的淋巴瘤风险升高，但结果不一致。系统评价和荟萃分析显示，接受抗 TNF-α 药物治疗的 RA 患者与接受常规治疗的患者相比，淋巴瘤的风险无显著差异。然而，鉴于纳入研究的局限性，需要进一步的研究来验证结果，并探讨可能导致 RA 患者发生淋巴瘤的潜在风险因素。
