甲氨蝶呤治疗类风湿关节炎有效性与安全性的系统评价  

Effectiveness and Safety of Methotrexate in the Treatment of Rheumatoid Arthritis:A Systematic Review

作　　者：兰瑛[1] 胡蝶[1] 宋海宁[1] 黄师婧[1] 何琴[1] 

机构地区：[1]成都市第三人民医院西药科,成都610031

出　　处：《中国药房》2016年第21期2928-2933,共6页China Pharmacy

基　　金：国家科技支撑计划子课题(No.2013BAI06B04Y023034)

摘　　要：目的：系统评价甲氨蝶呤（MTX）治疗类风湿关节炎的有效性与安全性,为临床提供循证参考。方法：计算机检索Medline、EMBase、Cochrane图书馆、Pub Med、中国期刊全文数据库、中国生物医学文献数据库（CBM）、中文科技期刊数据库和万方数据库,收集MTX治疗类风湿关节炎的随机对照试验,按纳入与排除标准筛选文献并评价偏倚风险,提取相关数据后进行系统评价。结果与结论：有效性分析纳入33篇,合计8 253例患者;安全性分析纳入53篇,合计4 803例患者。分析结果显示,MTX治疗类风湿关节炎疗效不高于来氟米特,优于环孢素A,与柳氮磺吡啶相似;与生物制剂比较,除疗效不及托珠单抗外,与依那西普（每周7.5~20 mg）、戈利木单抗、阿达木单抗、利妥昔单抗相似。MTX不良反应发生率高,但主要为轻中度症状,最常见为消化系统不良反应。口服MTX较皮下注射和肌内注射更安全。OBJECTIVE：To systematically review the effectiveness and safety of methotrexate（MTX）in the treatment of rheumatoid arthritis,and provide evidence-based reference for clinical treatment. METHODS：Retrieved from Medline,EMBase,Cochrane Library,Pub Med,CJFD,CBM,VIP and Wanfang Database,randomized controlled trials（RCT）about MTX in the treatment of rheumatoid arthritis were collected,Meta-analysis was performed after data extraction and quality evaluation. RESULTS CONCLUSIONS：33 effectiveness evaluation were included,involving 8 253 patients,and 53 safety evaluation were included,involving 4 803 patients. Results of analysis show,the efficacy of MTX was not higher than leflunomide in the treatment of rheumatoid arthritis,superior to cyclosporine A,and similar to sulfasalazine. In addition,MTX shows similar efficacy with etanercept（7.5-20 mg per week）,golimumab,adalimumab or rituximab,but less effective than trastuzumab. The incidence of adverse reactions of MTX is high,but mainly mild or moderate,and the most common adverse reactions are gastrointestinal symptoms. Oral administration of MTX is more secure than intramuscular injection and subcutaneous injection.

关 键 词：甲氨蝶呤 类风湿关节炎 有效性 安全性 系统评价 

分 类 号：R684.3[医药卫生—骨科学]