托法替布治疗类风湿关节炎发生呼吸道疾病风险的Meta分析

Risk of respiratory tract disease in rheumatoid arthritis treated with tofacitinib:a meta-analysis

目的评估接受托法替布治疗的类风湿关节炎(RA)患者发生呼吸道疾病的风险。方法检索PubMed、Embase、Web of Science、Cochrane Library数据库,搜索关于托法替布在RA患者中的双盲随机对照试验(RCT),检索时限为建库至2022年9月。使用Cochrane偏倚风险工具来评估纳入试验的质量,采用RevMan 5.3软件进行统计学分析,使用Mantel-Haenszel固定效应方法进行相对风险比较以评估结果。结果共纳入14项双盲RCT,合计6372例RA患者。Meta分析结果显示,与对照组相比,托法替布组下呼吸道感染风险显著升高(RR=2.32,95%CI:1.27~4.24,P=0.006),肺栓塞风险显著降低(RR=0.16,95%CI:0.03~0.94,P=0.04)。托法替布组上呼吸道感染、流感、肺炎、机会性呼吸道感染和其他非感染性呼吸道不良事件的发生风险与对照组相比差异无显著意义(P>0.05)。结论托法替布治疗RA会增加下呼吸道感染的发生风险,但与其他呼吸道疾病的发生风险无关。

AIM To evaluate the relative risk of respiratory tract disease in rheumatoid arthritis(RA)patients treated with tofacitinib.METHODS From PubMed,Embase,Web of Science,and Cochrane Library databases,the doubleblind randomized controlled trials(RCTs)of RA patients who treated with tofacitinib were searched,and the search time limit was from the establishment of the databases to September 2022.The Cochrane risk of bias tool was used to evaluate the quality of the included trials,the RevMan 5.3 software was used for statistical analysis,and the Mantel-Haenszel fixed-effects method was used for relative risk(RR)comparison to evaluate the results.RESULTS Fourteen double-blind RCTs were included,with a total of 6372 RA patients.The results of meta-analysis showed that compared with the control group,the risk of lower.respiratory tract infection was significantly increased in the tofacitinib group(RR=2.32,95%CI:1.27 to 4.24,P=0.006),while the risk of pulmonary embolism was significantly reduced(RR=0.16,95%CI:0.03 to 0.94,P=0.04).There was no significant difference in the risk of upper respiratory tract infection,influenza,pneumonia,opportunistic respiratory tract infection,and other non-infectious respiratory adverse events between the tofacitinib group and the control group(P>0.05).CONCLUSION Tofacitinib used for the treatment of RA will increase the risk of lower respiratory tract infection,but has no correlation with the risk of other respiratory tract diseases.