药物抗体与TNF拮抗剂疗效降低密切相关

作者：Wu C，et al.

翻译：北医三院 安文成

摘要：背景：肿瘤坏死因子拮抗剂已应用于类风湿关节炎的治疗，但有药物抗体的患者却无法从中受益，这篇Meta分析是为了进一步研究类风湿关节炎患者的药物抗体（ADAb+）与抗肿瘤坏死因子之间的关系。

方法：观察ADAb+和ADAb-两组患者的临床反应，以OR值、95%可信区间来评价，并对肿瘤坏死因子拮抗剂种类和药物抗体进行亚组分析。

结果：共纳入10个研究、1806个样本，在随访的类风湿关节炎患者中，药物抗体阳性与肿瘤坏死因子拮抗剂低反应密切相关，除外第3个月用ELISA法检测的酶相关免疫吸收剂、第6个月英夫利昔单抗与酶相关免疫吸收剂和第12个月的免疫多参数芯片技术这几个亚群，亚组分析也支持这一结论。

结论：药物抗体与肿瘤坏死因子拮抗剂作用减弱密切相关，对于有药物抗体的类风湿关节炎患者，应寻找其他替代性药物。

附原文：Background. Antitumor necrosis factor (anti-TNF) drugs have been applied for rheumatoid arthritis (RA) treatment; however, patients having anti-drug antibodies (ADAbs) do not benefit from these drugs. The meta-analysis aims to comprehensively assess the relationship between ADAb positive (ADAb+) and anti-TNF response in RA patients. Methods. Observational studies comparing different clinical response between ADAb+ and ADAb negative groups were included. Odds ratio (OR) with its corresponding 95% confidence interval (CI) was used as effect size. Subgroup analyses stratified by TNF inhibitor types and assay methods for ADAb detection were performed. Results. Totally, 10 eligible studies containing 1806 subjects were included. ADAb+ was significantly associated with reduced anti-TNF response to RA at all the time points after follow-up (P < 0.001). subgroup analysis also supported this significant association (p < 0.05), except for enzyme-linked immunosorbent assay (elisa) group at 3 months, infliximab (inf) and enzyme-linked immunosorbent assay (elisa) groups at 6 months, and immunological multi-parameter chip technology (impact) group at 12 months. conclusion. adab+ was significantly associated with reduced clinical response in ra patients, and other alternatives should be considered in ra patients presenting adab+.

引自：Wu C, Wang S, Xian P,et al. Effect of Anti-TNF Antibodies on Clinical Response in Rheumatoid Arthritis Patients: A Meta-Analysis. Biomed Res Int. 2016 Jul 31.