類風濕性關節炎使用tocilizumab與TNF抑制劑和其他生物製劑治療相比對下消化道穿孔的風險：系統性回顧與統合分析

Risk of lower gastrointestinal perforation in patients with rheumatoid arthritis treated with tocilizumab compared to TNF inhibitors and other biologics: A systematic review and meta-analysis

目的：本研究探討類風濕性關節炎患者中，接受tocilizumab與TNF抑制劑和其他生物製治療後，產生下消化道穿孔之風險比較。
方法：搜尋2005年1月至2023年5月間在PubMed和Embase數據庫上發布的研究。主要指標為比較使用tocilizumab和TNF抑制劑治療與下消化道穿孔風險之間的關係。次要指標是比較使用tocilizumab和其他生物製劑治療與下消化道穿孔風險之間的關係。
結果：本研究分析包括了四篇觀察性研究。主要指標顯示tocilizumab和TNF抑制劑治療的風濕性關節炎患者之下消化道穿孔的比率比為2.547（95%信賴區間=1.192-5.444）。次要指標分析顯示tocilizumab與rituximab治療的風濕性關節炎患者之下消化道穿孔的比率比為1.911 ( 95%信賴區間=0.668–5.469）tocilizumab與abatacept的比率比為1.445 ( 95%信賴區間= 0.560–3.727）。這兩種治療方法下的下消化道穿孔風險無顯著差異。與tocilizumab相關的下消化道穿孔風險率為0.003（事件/人年）。漏斗圖分析顯示，對於主要和次要指標，都沒有顯著的出版偏差（p = 0.31和0.35，Egger’s測試）。
結論：接受tocilizumab治療的類風溼性關節炎患者的下消化道穿孔風險高於接受TNF抑制劑治療的患者。然而，接受tocilizumab治療的類風溼性關節炎患者與接受rituximab和abatacept治療的患者相比，下消化道穿孔的風險並未增加。

Objectives: To compare the lower gastrointestinal (GI) perforation (GIP) risks in patients with rheumatoid arthritis (RA) treated with tocilizumab (TCZ) and other biologics.
Methods: The PubMed and Embase databases were searched for studies published from January 2005 to May 2023. The primary objective was to compare the lower GIP risks associated with TCZ and tumor necrosis factor inhibitors (TNFis). The secondary objective was to compare the lower GIP risks associated with TCZ and other biologics.
Results: The analysis incorporated four observational studies. The primary outcome was the rate ratio (RR) of lower GIP for patients with RA treated with TCZ and TNFis, which was 2.547 (95% confidence interval [CI] = 1.192–5.444). The secondary outcome analysis revealed no significant difference in the risk of lower GIP between the patients treated with TCZ and those treated with rituximab (RTX; RR = 1.911, 95% CI = 0.668–5.469) or abatacept (ABA; RR = 1.445, 95% CI = 0.560–3.727). The rate of lower GIP risk associated with TCZ was 0.003 (events/person-year). The funnel plot analysis indicated no significant publication bias for both the primary and secondary outcomes (p = 0.31 and 0.35, respectively; Egger’s test).
Conclusions: The risk of lower GIP is higher in patients with RA treated with TCZ than for those treated with TNFis. However, the risk of lower GIP in patients with RA treated with TCZ was not higher relative to those treated with RTX and ABA.