systematic review and meta-analysis of the efficacy and safety of existing tnf blocking agents in treatment of rheumatoid arthritis疗效和安全性的系统回顾和荟萃分析现有tnf阻断剂治疗类风湿性关节炎.pdf

Systematic Review and Meta-Analysis of the Efficacy and Safety of Existing TNF Blocking Agents in Treatment of Rheumatoid Arthritis 1 2 3 ¨ 2,4 ¨ 5 Kalle J. Aaltonen , Liisa M. Virkki , Antti Malmivaara , Yrjo T. Konttinen *, Dan C. Nordstrom , Marja Blom6 1 Faculties of Pharmacy and Medicine, University of Helsinki, Helsinki, Finland, 2 Faculty of Medicine, University of Helsinki, Helsinki, Finland, 3 Centre for Health and Social Economics, National Institute for Health and Welfare (THL), Helsinki, Finland, 4 COXA Hospital for Joint Replacement, Tampere, Finland, 5 Helsinki University Central Hospital (HUCH), Helsinki, Finland, 6 Faculty of Pharmacy, University of Helsinki, Helsinki, Finland Abstract Background and Objectives: Five-tumour necrosis factor (TNF)-blockers (infliximab, etanercept, adalimumab, certolizumab pegol and golimumab) are available for treatment of rheumatoid arthritis. Only few clinical trials compare one TNF-blocker to another. Hence, a systematic review is required to indirectly compare the substances. The aim of our study is to estimate the efficacy and the safety of TNF-blockers in the treatment of rheumatoid arthritis (RA) and indirectly compare all five currently available blockers by combining the results from included randomized clinical trials (RCT). Methods: A systematic literature review was conducted using databases including: MEDLINE, SCOPUS (including EMBASE), Cochrane library and electronic search alerts. Only articles reporting double-blind RCTs of TNF-blockers vs. placebo, with or without concomitant methotrexate (MTX), in treatment of RA were selected. Data collected were information of patients, interventions, controls, outcomes, study methods