Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis
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Rheumatologie Originalien Z Rheumatol https://doi.org/10.1007/s00393-020-00944-7 Accepted: 27 November 2020 © The Author(s) 2020 Redaktion U. Müller-Ladner, Bad Nauheim U. Lange, Bad Nauheim
L.-J. Chen1 · Y.-J. Zhou2 · Z.-H. Wen1 · F. Tian1 · J.-Y. Li1 1
Department of Rheumatology and Immunology, The Affiliated ZhuZhou Hospital of XiangYa Medical College, Central South University, ZhuZhou, China 2 Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis A systematic review and meta-analysis of randomized controlled trials
Introduction Rheumatoid arthritis (RA) is an inflammatory disease of synovial joints that affects approximately 1% of the population [1]. In the absence of treatment, deteriorating joints can result in pain and stiffness, which limit physical function and lead to long-term disability [2]. RA is a potentially destructive disease that has a profound impact on functioning and quality of life among patients. At present, RA treatment remains a challenge for rheumatologists worldwide. Based on the course, disease activity, prognostic factors, and prior experience with disease-modifying antirheumatic drug (DMARDs) in the treatment of RA, the American College of Rheumatology (ACR) 2015 guidelines recommend the use of traditional antirheumatic agents and biological DMARDs. If methotrexate (MTX) is not found to be effective, methotrexate in combination with other DMARDs such as biologics will be recommended. However, the use of biological DMARDs to treat RA is not suitable for all patients for various reasons, including complications, side effects, uncertain efficacy, and high costs that prevent their use. Therefore, a new anti-rheumatic drug combined with MTX is urgently needed in the
treatment of RA, especially for drug switching and cost reduction. Iguratimod (IGU) is a new synthetic diseasemodifying antirheumatic drug (small molecule), whereby its mechanism of action is still not completely clear [3]. At the molecular level, iguratimod inhibits the invasiveness of rheumatoid synovial fibroblasts by decreasing matrix metalloproteinase (MMP-1 and MMP3) production [4], and it also inhibits the activation of MAPKs and the NFkappa B pathway in RANKL-induced osteoclastogenesis in RAW264.7 cells, which can prevent bone destruction [5]. The production of IgG, IgM, and IgA was significantly reduced in active RA patients who were treated with IGU compared with those treated with placebo in some studies [6, 7]. Therefore, IGU has been considered a clinically useful DMARD with a unique mechanism of action, and its improvement rate of the ACR20 was not lower than that of sulfasalazine in patients with active RA (57.7% compared with 63.1%) [8]. Although the available study population is mainly East Asian (Japan and China up to date), and with the consequence that transfer of results to other ethnicities is questionable, we still need this research to
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