- 期刊
Comparative Safety of bDMARDs and tsDMARDs for the Treatment of Rheumatoid arthritis: A Systematic Review and Network Meta-Analysis
摘要
To compare the relative clinical safety of biologic disease‐modifying anti‐rheumatic drugs (bDMARDs) and targeted synthetic disease‐modifying anti‐rheumatic drugs (tsDMARDs) (adalimumab, infliximab, certolizumab pegol, golimumab, tocilizumab, sarilumab, tofacitinib, baricitinib, upadacitinib, peficitinib, filgotinib, abatacept, anakinra, rituximab) in patients with rheumatoid arthritis (RA) who had been treated with conventional synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs) without adequate response by network meta‐analysis. Eight databases include PubMed, The Cochrane library, Web of science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and Chinese Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCTs) of bDMARDs and tsDMARDs in the treatment of RA. The search period was established until February 18, 2023. The included RCTs were assessed for quality according to the bias risk assessment tool provided in the Cochrane Manual. The network meta‐analysis based on the Bayesian framework was performed in R software (version 4.1.3) called the gemtc package (version 1.0‐1) combined with the JAGS software, using the Markov chain Monte Carlo (MCMC) method. Safety outcomes included the incidence of adverse events (AEs), serious adverse events (SAEs), and discontinuations due to AEs. The included 64 RCTs, totaling 30103 patients with RA were analyzed. There were 64, 53 and 52 studies reported the outcomes of AEs, SAEs, and discontinuations due to AEs respectively. In conclusion, peficitinib and sarilumab were ranked relatively worse than other interventions in the incidence of AEs. Regarding to the incidence of SAEs, the order of golimumab and certolizumab pegol was relatively lower than other interventions. Sarilumab and tocilizumab were ranked lower than other interventions in the incidence of discontinuations due to AEs. When patients treated with golimumab and certolizumab pegol, it was recommended that the signs of infection should be monitored in time.