Efficacy and Safety of Anti-TNF alpha Therapy for Uveitis Associated with Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis

作者全名："Li, Yulu; Mao, Xiaolan; Tang, Xuemei; Mao, Huawei"

作者地址："[Li, Yulu; Mao, Xiaolan; Tang, Xuemei; Mao, Huawei] Chongqing Med Univ, Dept Rheumatol & Immunol,Childrens Hosp, Natl Clin Res Ctr Child Hlth & Disorders,Key Lab, Chongqing Key Lab Child Infect & Immun,Minist Edu, Chongqing, Peoples R China; [Mao, Huawei] Capital Med Univ, Beijing Childrens Hosp, Natl Ctr Childrens Hlth, Dept Immunol, Beijing, Peoples R China"

通信作者："Mao, HW (corresponding author), Chongqing Med Univ, Dept Rheumatol & Immunol,Childrens Hosp, Natl Clin Res Ctr Child Hlth & Disorders,Key Lab, Chongqing Key Lab Child Infect & Immun,Minist Edu, Chongqing, Peoples R China."

来源：RHEUMATOLOGY AND THERAPY

ESI学科分类：　

WOS号：WOS:000629082800001

JCR分区：Q2

影响因子：3.8

年份：2021

卷号：8

期号：2

开始页：711

结束页：727

文献类型：Review

关键词：Anti-TNFα therapy; Efficacy; Juvenile idiopathic arthritis; Meta-analysis

摘要："Introduction To investigate the efficacy and safety of anti-TNF alpha therapy in patients with juvenile idiopathic arthritis associated uveitis (JIA-U). Methods Embase, PubMed, Cochrane Library, and Web of Science were systematically searched for studies reporting anti-TNF alpha treatment in patients with JIA-U. The primary outcome was the control of intraocular inflammation (CII). The pooled proportion of CII was assessed by the random-effects method when I-2 > 50%, otherwise, by the fixed-effect method. This study was registered with PROSPERO (CRD42020161749). Results Three randomized clinical trials (RCTs), twelve case series, three retrospective cohort studies, and three case reports were identified. A total of 399 patients were receiving anti-TNF alpha therapy, of which 201 patients were treated with adalimumab (ADA), 139 with infliximab (IFX), 36 with etanercept (ETA), 20 with golimumab (GLM), and 3 with certolizumab pegol (CZP). The pooled proportions of CII on observational studies were 82% (95% CI 63-96%) in patients receiving ADA, 56% (95% CI 30-80%) in IFX, 38% (95% CI 8-73%) in ETA and 65% (95% CI 42-86%) in GLM, respectively. All three patients treated with CZP reached improved activity. ADA therapy led to a significantly higher proportion of CII compared to IFX therapy (chi(2) = 26.24, P < 0.001), or to ETA therapy (chi(2) = 13.43, P < 0.001); but no statistical difference was observed between IFX and ETA (chi(2) = 0.13, P = 0.71). As to safety, most reported adverse events were tolerable and two cohort studies consistently showed that ADA was safer than IFX. Conclusions The existing evidence suggests that ADA is better than IFX regarding efficacy and safety. The effectiveness of IFX is higher than ETA with no statistical difference. GLM and CZP may be proxies for ADA but the evidence is limited."

基金机构：National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81971547]; Research Fund for Outstanding Youth Scholar of Chongqing Talents [CQYC201905003]

基金资助正文：Sponsorship for this study and Rapid Service Fee were funded by the National Natural Science Foundation of China (81971547) and the Research Fund for Outstanding Youth Scholar of Chongqing Talents (CQYC201905003).