科研之友
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摘要
Background Anti-tumor necrosis factor-alpha (TNF-alpha) agents have considerable advances in treating inflammatory bowel disease (IBD). These drugs carry possible risk of adverse symptoms, and no meta-analysis has examined this issue and the potential duration-response relationship. Purpose The purpose of this study was to assess duration-response relationship between anti-TNF-alpha agents and risk of adverse symptoms from all available randomized control trials (RCTs) with placebo arms in IBD. Methods PubMed, OVID, and Cochrane Library were searched to January 2015. The RCTs comparing anti-TNF-alpha therapy with placebo in adults with IBD were eligible. We estimated pooled relative risks (RRs) of adverse symptoms for anti-TNF-alpha therapy and examined both non-linear and linear duration-response relations between therapy duration and significant related adverse symptoms. Results Twenty-three RCTs with 7325 patients were included. Adverse symptoms of headache, nausea/vomit, abdominal pain, fever, and arthralgia showed no significant relationship with anti-TNF-alpha therapy, respectively. Fatigue was significantly associated with anti-TNF-alpha therapy (RR 1.35, 95 % confidence interval (CI) 1.01-1.81), and subgroup analysis indicated that long therapy duration (> 30 weeks) and combination without azathioprine (AZA) were two risk factors for the occurrence of fatigue (RR 1.74, 95 % CI 1.03-2.93; RR 1.65, 95 % CI 1.13-2.40). In the trials without AZA combination, there was a linear duration-response relationship between therapy duration and risk of fatigue (P = 0.0217), and duration of 35 weeks increased the risk of fatigue by 50 %. Conclusion This meta-analysis suggested a promotive effect of anti-TNF-alpha therapy to the occurrence of fatigue, and for the anti-TNF-alpha therapy without AZA combination, a linear duration-response relationship existed between therapy duration and risk of fatigue.
- 出版日期2015-8
- 单位武汉大学
