Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis

2017 ◽  
Vol 77 (1) ◽  
pp. 98-103 ◽  
Author(s):  
Claire Rempenault ◽  
Bernard Combe ◽  
Thomas Barnetche ◽  
Cécile Gaujoux-Viala ◽  
Cédric Lukas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Diseases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Cochrane Library ◽  
Diabetes Incidence ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Mean Differences ◽  
High Density Cholesterol

ObjectiveCardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA.MethodsWe systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another.ResultsThe literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were −9.8 (95% CI −14.0 to −5.6), −10.6 (95% CI −14.2 to −7.0), +4.1 (95% CI 2.2 to 6.0) and −19.2 (95% CI −27.2 to −11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis.ConclusionBesides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.

scholarly journals Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis

2020 ◽  
Author(s):  
L.-J. Chen ◽  
Y.-J. Zhou ◽  
Z.-H. Wen ◽  
F. Tian ◽  
J.-Y. Li
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Combined Treatment ◽  
Cochrane Collaboration ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
American College Of Rheumatology ◽  
The Cochrane Collaboration

AbstractThe current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13–1.74), 2.09 (95% CI, 1.67–2.61), and 2.24 (95% CI, 1.53–3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92–1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.

scholarly journals Unravelling the Ameliorative Effects of Probiotics in Rheumatoid Arthritis: A Meta-analysis of Randomized, Controlled Trials

2021 ◽  
Author(s):  
Dongsong Liu ◽  
Qin Xu ◽  
Feng Zhang ◽  
Hong Cao ◽  
Xuesong Wang
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Joint Inflammation ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Tender Joint ◽  
Randomized Controlled ◽  
American College Of Rheumatology ◽  
Hs Crp

Abstract Background: Recent studies have shown that rational regulation of the gut microbiota, known as probiotic supplements, have beneficial consequences on rheumatoid arthritis (RA). However, their efficacy as an adjunct therapy remains controversial. Methods: PubMed, Embase, Scopus, Web of science and Cochrane Library was performed to retrieve the existing data from the published randomized, controlled trials (RCTs) comparing probiotics with placebo in RA through August 2021. Among eight RCTs were eligible for inclusion in this meta-analysis, and all data were analyzed by StataSE 12.1 software. Results: The probiotic has achieved significant improvement in visual analogue scales (VAS), high sensitive C-reactive protein (hs-CRP), tumor necrosis factor (TNF-α) and interleukin (IL-1β). Probiotic may have a beneficial role in disease activity score in 28 joints (DAS28). However, probiotic does not have a significant effect on tender joint, swollen joint and lipid levels and not yet achieve obvious improvement in American College of Rheumatology 20% improvement criteria (ACR20). Conclusion: Probiotics have a beneficial effect on improving RA to some extent, especially on alleviating joint inflammation. However, the number of studies was too small to determine if a strain-, dose-, or duration-response effect was present. More multi-centered, large-sample RCTs are needed to explore the benefits of probiotic to RA patients in the future.

scholarly journals Chinese traditional medicine (GuiZhi-ShaoYao-ZhiMu decoction) as an add-on medication to methotrexate for rheumatoid arthritis: a meta-analysis of randomized clinical trials

2021 ◽  
Vol 12 ◽  
pp. 204062232199343
Author(s):  
Chenxi Feng ◽  
Rongrong Chen ◽  
Keer Wang ◽  
Chengping Wen ◽  
Zhenghao Xu
Keyword(s):  
Rheumatoid Arthritis ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Effective Rate ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Tender Joint ◽  
American College Of Rheumatology ◽  
Language Studies

Background: GuiZhi-ShaoYao-ZhiMu decoction (GSZD), a traditional Chinese herbal medication, has been frequently used as an add-on medication to methotrexate (MTX) for rheumatoid arthritis (RA) treatment in China. This meta-analysis evaluated the efficacy and safety of adding GSZD to MTX for RA treatment. Methods: We performed a systematic search of PubMed, Web of Science, EMBASE, and the Cochrane Library (all databases) for English-language studies and WanFang, VIP, and CNKI for Chinese-language studies up to 28 July 2020. Data from selected studies, mainly the response rates and rate of adverse events (AEs), were extracted independently by two authors, and a random-effects model (Mantel–Haenszel method) was used for the meta-analysis. Results: A total of 14 randomized controlled trials and 1224 patients were included (623 patients in the GSZD + MTX group and 601 patients in the MTX group). For efficacy, the meta-analysis found that combining GSZD with MTX increased the effective rate [relative risk (RR) = 1.24, 95% confidence interval (CI): 1.18–1.30, based on 1069 patients], defined as >30% efficacy, American College of Rheumatology 20, or a decrease of disease activity score 28 >0.6. Adding GSZD reduced the swollen and tender joint counts, the duration of morning stiffness, the levels of C-reactive protein and rheumatoid factor, and erythrocyte sedimentation rate. The adjuvant therapeutic effect of GSZD was independent of the dose of MTX or the combined utilization of other drugs in both groups. For safety, adding GSZD was associated with a lower rate of total AEs (RR = 0.46, 95% CI: 0.26–0.83, based on 615 patients) and gastrointestinal tract AEs (RR = 0.46, 95% CI: 0.24–0.88, based on 537 patients). Conclusion: Combining GSZD with MTX may be a more efficacious and safer strategy for treating RA compared with MTX alone. Further large studies are warranted to investigate the long-term efficacy and safety of adding GSZD to MTX for RA treatment.

scholarly journals OP0214 INCIDENCE OF CANCER (RELAPSE OR NEW ONE) FOLLOWING BDMARDS INITIATION IN PATIENT WITH RHEUMATOID ARTHRITIS AND HISTORY OF CANCER: A SYSTEMATIC REVIEW WITH META-ANALYSIS OF OBSERVATIONAL STUDIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 133.2-133
Author(s):  
A. Wetzman ◽  
T. Barnetche ◽  
C. Lukas ◽  
C. Gaujoux-Viala ◽  
B. Combe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Tnf Inhibitors ◽  
Cochrane Library ◽  
Risk Of Recurrence ◽  
American College Of Rheumatology ◽  
Skin Cancers ◽  
History Of ◽  
History Of Cancer ◽  
Risk Of Relapse

Background:The tolerance of targeted biologic therapies (bDMARDs) used in rheumatoid arthritis (RA) has been studied in patients with no history of cancer. A 5-year cancer remission is recommended to initiate treatment with bDMARDs. However, in the context of the aging of the population and the increase in screening for neoplasia, the question of targeted treatment in a patient with RA with a history of cancer is usual.Objectives:To determine the risk of recurrence or a new malignancy when exposed to a b-DMARDs in adults with RA and a history of cancer.Methods:A systematic literature search of EMBASE, MEDLINE, Cochrane Library, and electronic abstract databases of the annual scientific meetings of both the European League Against Rheumatism and the American College of Rheumatology was conducted through June 2019 and selected all cohort follow-up studies including adults with RA with a history of cancer and treated with b-DMARDs (TNF inhibitors, rituximab, abatacept and tocilizumab). We compared the risk of relapse or new cancer onset between the groups treated with and without b-DMARDs. The RevMan 5.3 software was used to calculate the cumulative risks from each group’s Hazard Ratio (HR), with their 95% confidence intervals. The heterogeneity of the studies was evaluated by the Cochran Q test and expressed with the I2value.Results:26 observational cohort studies were selected, of which 12 were included in the meta-analysis. The overall risk of new cancer or recurrence of neoplasia in RA patients with a history of cancer, compared to control subjects, for all b-DMARDs combined was 1.09 (p=0.29, 95%CI [0.92-1.32], I2=16%). The risk of relapse or new cancer onset in patients exposed to TNF inhibitors was 1.11 (p=0.45, 95%CI [0.85-1.46], I2=48%) and 0.79 (p=0.49, 95%CI [0.41-1.53], I2=10%) for rituximab. The rate of recurrence was 1.32 (p=0.04, 95%CI [1.02-1.72], I2=0%) for skin cancer, 1.28 (p=0.07, 95%CI [0.98-1.67], I2=0%) for skin cancers excluding melanoma and 1.21 (p=0.31, 95%CI [0.84-1.72], I2=0%) for breast neoplasia.Conclusion:This is the first meta-analysis evaluating the risk of recurrence or new cancers in a RA population with a history of neoplasia exposed to b-DMARD. For patients with a history of cancer, for whom the benefit / risk balance has been found to be favorable, the initiation of b-DMARD treatment for RA does not seem to significantly increase the risk of recurrence or new cancer compared to patients naïve to biological treatments, apart from skin cancers including melanoma.Disclosure of Interests:Amélie Wetzman: None declared, Thomas Barnetche: None declared, Cédric Lukas: None declared, Cecile Gaujoux-Viala: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Jacques Morel: None declared, Paulina Szafors: None declared

scholarly journals A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Binbin Xie ◽  
Jiang He ◽  
Yong Liu ◽  
Ting Liu ◽  
Chaoqun Liu
Keyword(s):  
Rheumatoid Arthritis ◽  
Cholesterol Efflux ◽  
Human Subjects ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Quality Of Evidence ◽  
Cholesterol Efflux Capacity ◽  
Mean Differences

Abstract Background Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, current evidence is inconsistent, especially in rheumatoid arthritis (RA) patients. This meta-analysis aims to identify whether CEC is impaired or altered by drug therapy in RA. Methods The PubMed/MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases were browsed to identify studies on CEC in RA patients. The searches mainly focused on studies in human subjects that were published before November 14, 2020, without any language restrictions. The effect size was pooled by the standardized mean differences and mean differences (SMD & MD) as well as the corresponding 95% confidence intervals (CIs) in a random or fixed effect model. Heterogeneity across the studies was tested using Cochran’s Q test and I2 statistic. Newcastle-Ottawa Scale and the Downs and Black scale (D&B) were applied to evaluate the quality of included studies. The GRADE-system with its 4-grade evidence scale was used to assess the quality of evidence. Results A total of 11 eligible articles, including 6 observational and 5 interventional studies, were retrieved. The pooled results showed that in patients with RA, CEC was not significantly different than in healthy controls (SMD: -0.34, 95% CI: − 0.83 to 0.14), whereas the plasma HDL-C levels was significantly lower (MD: -3.91, 95% CI: − 7.15 to − 0.68). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.02 to 0.37) increased, but the plasma HDL-C levels (MD: 3.63, 95% CI: − 0.13 to 7.39) remained at a comparable quantity after anti-rheumatic treatment comparing with the baseline. In addition, the funnel plot of included studies displayed a lightly asymmetry, while Egger’s and Begg’s test did not suggest the existence of publication bias. The quality of evidence was rated according to GRADE as moderate to very low. Conclusion The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of the plasma HDL-C levels. However, the results should be interpreted with caution because of low-quality and limited quantity of evidence. Future randomized controlled trials are needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.

Effect of antihypertensive drugs on cognition and behavioral symptoms of patients with Alzheimer’s disease: A meta-analysis

2020 ◽  
Vol 21 ◽  
Author(s):  
Roja Rahimi ◽  
Shekoufeh Nikfar ◽  
Masoud Sadeghi ◽  
Mohammad Abdollahi ◽  
Reza Heidary Moghaddam ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
Behavioral Symptoms ◽  
Cochrane Library ◽  
Mean Differences ◽  
Global Impression Of Change ◽  
State Examination

Background: It has been found that there is a link between hypertension and elevated risk of Alzheimer’s disease (AD). Herein, a meta-analysis based on randomized clinical trials (RCTs) was used to assess the effect of antihypertensive drugs on cognition and behavioral symptoms of AD patients. Method: The three databases – PubMed/Medline, Scopus, and Cochrane Library- were searched up to March 2020. The quality of the studies included in the meta-analysis was evaluated by the Jadad score. Clinical Global Impression of Change (CGIC) included in two studies, Mini-Mental State Examination (MMSE) included in three studies, and Neuropsychiatric Inventory (NPI) in three studies were the main outcomes in this systematic review. Results: Out of 1506 studies retrieved in the databases, 5 RCTs included and analyzed in the meta-analysis. The pooled mean differences of CGIC, MMSE, and NPI in patients with AD receiving antihypertensive drugs compared to placebo was -1.76 with (95% CI = -2.66 to -0.86; P=0.0001), 0.74 (95% CI = 0.20 to 1.28; P= 0.007), and -9.49 (95% CI = -19.76 to 0.79; P = 0.07), respectively. Conclusion: The findings of the present meta-analysis show that antihypertensive drugs may improve cognition and behavioral symptoms of patients with AD. However, more well-designed RCTs with similar drugs are needed to achieve more conclusive results.

scholarly journals Effect of somatometric parameters on the prevalence and severity of varicocele: a systematic review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Runqing Li ◽  
Junjie Liu ◽  
Yushan Li ◽  
Quanxian Wang
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Random Effects Models ◽  
Knowledge Infrastructure ◽  
Regression Test ◽  
Mean Differences ◽  
Q Statistic ◽  
The Relationship

Abstract Background Published studies have shown contradictory results regarding the relationship between somatometric parameters and varicoceles. We performed a systematic review and meta-analysis to investigate the possible effects of age, height, weight, and body mass index (BMI) on the presence and severity of varicoceles. Methods Databases including EMBASE, MEDLINE, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Web of Science, and Google Scholar were systematically searched to identify relevant articles published up to March 2020. Two researchers independently identified eligible articles and extracted data. Cochran’s Q statistic and I2 statistics were used to assess heterogeneity. Meta-analysis was performed using StataSE 12.0 software (StataCorp LP, USA). Random-effects models were used to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Publication bias was assessed using Begg’s funnel plot and Egger’s regression test. Results The search strategy produced 272 articles, of which 18 articles were eligible according to the inclusion/exclusion criteria. A total of 56,325 patients with varicocele and 1,334,694 patients without varicocele were included in the meta-analysis to evaluate the effect of somatometric parameters on the presence and severity of varicocele. The overall results demonstrated that the presence of varicoceles was significantly associated with height (WMD = 1.41, 95% CI = 1.07 to 1.74, P < 0.001) and inversely correlated with BMI (WMD = − 1.35, 95% CI = -1.67 to − 1.03, P < 0.001) but not with age (WMD = -0.93, 95% CI = -2.19 to 0.33, P = 0.149) or weight (WMD = 0.24, 95% CI = -2.24 to 2.72, P = 0.850). The severity of varicocele was inversely correlated with increased BMI but not with age. Conclusion The presence of varicoceles was significantly associated with height and inversely correlated with BMI.

scholarly journals Association between serum visfatin levels and psoriasis and their correlation with disease severity: a meta-analysis

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110023
Author(s):  
Qian Zou ◽  
Jiawei Si ◽  
Yatao Guo ◽  
Jiayu Yu ◽  
Huijuan Shi
Keyword(s):  
Body Mass Index ◽  
Meta Analysis ◽  
Severity Index ◽  
Cochrane Library ◽  
Control Group ◽  
Inclusion Criteria ◽  
Subgroup Analyses ◽  
Mean Differences ◽  
The Cochrane Library ◽  
Psoriasis Severity

Objective To determine the association between serum visfatin levels and psoriasis and to evaluate the correlation between serum visfatin levels and the severity of psoriasis. Methods The electronic databases PubMed®, Embase® and the Cochrane Library were searched for articles published from inception to 1 May 2020. Data were extracted and then standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pooled estimates. Results A total of 11 studies met the inclusion criteria and were included (448 patients diagnosed with psoriasis and 377 controls). This meta-analysis demonstrated that patients with psoriasis had significantly higher levels of visfatin than the controls (SMD = 0.90, 95% CI 0.52, 1.28). Subgroup analyses showed that differences in serum visfatin levels between the patient group and the control group were associated with ethnicity, Psoriasis Area and Severity Index (PASI) and body mass index. Additionally, a meta-analysis of correlations showed that visfatin levels in patients with psoriasis were positively correlated with PASI ( r = 0.51, 95% CI 0.14, 0.75). Conclusions This meta-analysis showed that serum visfatin levels in patients with psoriasis were significantly higher than those in the controls and a positive correlation between serum visfatin levels and psoriasis severity was observed.

scholarly journals Effect of Tai Chi on Markers of Oxidative Stress: Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (7) ◽  
pp. 3458
Author(s):  
Juana Rosado-Pérez ◽  
Osvaldo D. Castelán-Martínez ◽  
Abril J. Mújica-Calderón ◽  
Martha A. Sánchez-Rodríguez ◽  
Víctor Manuel Mendoza-Núñez
Keyword(s):  
Oxidative Stress ◽  
Systematic Review ◽  
Superoxide Dismutase ◽  
Sedentary Behavior ◽  
Tai Chi ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Stress Markers ◽  
Markers Of Oxidative Stress ◽  
Mean Differences

Background: This study aimed to synthesize the evidence of the effect of practicing Tai Chi on oxidative stress markers (OxSM). Methods: This systematic review and meta-analysis was conducting using the MEDLINE, Cochrane Library, ScienceDirect, Scopus, Epistemonikos, Lilacs, and Ovid databases to identify randomized (RCT) and non-randomized (NRCT) clinical trials that evaluated the Tai Chi effect on OxSM compared to sedentary behavior, walking or yoga. Pooled mean differences (MDs) with 95% confidence intervals (95%CI) were estimated using the inverse variance method to determine the effect of Tai Chi on OxSM. PROSPERO register: CRD42019138362. Results: Five RCT and five NRCT were included. Compared to sedentary behavior, regular Tai Chi practice increases the levels of the enzymes superoxide dismutase (MD = 34.97 U/mL, (95%CI, 9.45 to 60.48), 344 participants) and catalase (MD = 15.63 U/mL, (95%CI, 4.05 to 27.22), 110 participants), as well as reducing the levels of lipoperoxides (MD = −0.02 µmol/L, (95%CI, −0.04 to −0.00), 234 participants). For comparisons with walking or yoga, only one study per activity was identified comparing the effect on OxSM. Conclusions: Regular Tai Chi practice increases the levels of superoxide dismutase and catalase, as well as reducing the levels of lipoperoxides. More studies are necessary to determine the effect of Tai Chi on OxSM when compared to other physical activities.

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