Cyclosporine for treating rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

Rheumatoid arthritis (RA) is an autoimmune disease characterized by an activation of T lymphocyte and an increase in interleukine turnover. In RA, cyclosporine is known to be efficient as a Disease Modifying Anti-Rheumatic Agent (DMARD), especially when other treatments such as injectable gold, D-penicillamine or anti-malarials were not efficacious.

Objectives

To estimate the short-term (up to one year) effects of cyclosporine for rheumatoid arthritis.

Search methods

We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles.

Selection criteria

All randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing cyclosporine against placebo in patients with rheumatoid arthritis.

Data collection and analysis

Two reviewers determined the trials to be included based on inclusion and exclusion criteria (GW, MSA). Data were independently abstracted by two reviewers (DH, GW),and checked by a third reviewer (BS) using a pre-developed form for the rheumatoid arthritis sub-group of the Cochrane Musculoskeletal Group.

Methodological quality of the RCTs and CCTs was assessed by two reviewers (BS, DH). Rheumatoid arthritis outcome measures were extracted from the publications for change from baseline endpoints. Sufficient data were obtained to include in the pooled analysis the number of swollen joints, physician global assessment, patient global assessment and erythrocyte sedimentation rate (ESR).

Main results

Three trials and 318 patients were included. A statistically significant decrease in the number of tender and swollen joints was observed for cyclosporine when compared to placebo. The standardized mean difference (SMD) for the change in the number of swollen joints was -0.969. Significant improvements in pain and the functional index were also found for cyclosporine. More side effects occurred in the cyclosporine group compared to placebo.

Authors' conclusions

Cyclosporine has an important clinical benefit in the short-term (up to one year) treatment of patients with progressive rheumatoid arthritis.

摘要

背景

環孢靈(Cyclosporine)治療類風濕性關節炎

類風濕性關節炎是自體免疫疾病,特徵為活化T淋巴細胞及Interleukine轉換增加。環孢靈(Cyclosporine)治療類風濕性關節炎為有效之修飾病程抗風濕藥物(DMARD),尤其注射金製劑、Dpenicillamine或抗瘧疾藥物治療無效時。

目標

本文評估抗環孢靈在治療類風濕性關節炎的短期﹝至多1年﹞療效與副作用。

搜尋策略

搜尋包括Cochrane Musculoskeletal Group trials register及MEDLINE (直到1997),同時手動搜尋所選文章之參考文獻,及詢問專家其它發表及未發表文獻。

選擇標準

所有比較環孢靈與安慰劑於類風濕性關節炎病人之隨機對照及控制對照臨床研究。

資料收集與分析

兩位作者獨立進行資料摘錄,並由第三位評審驗證。每篇試驗研究的品質由兩位作者獨立評估。類風濕性關節炎病人之結果測量為試驗之起始與終點之差異。腫脹關節數目、醫師整體評估、病患整體評估、及紅血球沉降速率有足夠數據做統合分析。

主要結論

3個研究包含318例病患於分析中。環孢靈比安慰劑組之疼痛及腫脹關節數目,統計上顯著減少。腫脹關節數目減少的標準化平均差異為0.969。在疼痛進步及功能指標上環孢靈組亦有進步。環孢靈組比安慰劑組有較多副作用。

作者結論

環孢靈在進行性類風濕性關節炎的短期﹝1年﹞治療有重要臨床助益。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結

Plain language summary

Cyclosporine for treating rheumatoid arthritis

This review included three trials with a total of 318 patients. A statistically significant decrease in the number of tender and swollen joints was found for patients taking cyclosporine when compared to those taking placebo. Significant improvements in pain and function were also found for those patients taking cyclosporine. More side effects occurred in the cyclosporine group compared to the placebo group.

Cyclosporine has an important clinical benefit in the short-term (up to one year) treatment of patients with progressive rheumatoid arthritis.

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