Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (33): 5404-5412.doi: 10.12307/2021.334

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Network meta-analysis of different drugs for the treatment of ankylosing spondylitis

Jia Hongsheng1, Li Xianlin2, Cai Lei1, Zhang Chongfeng1, Chen Zuchuang1, Zhang Ye1   

  1. 1Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China; 2Department of Orthopedics and Traumatology, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
  • Received:2021-01-07 Revised:2021-01-08 Accepted:2021-02-07 Online:2021-11-28 Published:2021-08-06
  • Contact: Li Xianlin, Chief physician, Master’s supervisor, Department of Orthopedics and Traumatology, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
  • About author:Jia Hongsheng, Master candidate, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China

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Abstract: OBJECTIVE: Clinical studies have found that sulfasalazine, etanercept, Yisaipu (recombinant human tumor necrosis factor receptor type II antibody fusion protein for injection), thalidomide and other drugs can significantly improve the symptoms and quality of life of patients with ankylosing spondylitis, but there is no evaluation system. This article systematically evaluated the difference of clinical efficacy and safety of different drugs in the treatment of ankylosing spondylitis. 
METHODS: Computer was used to search CNKI, Wanfang Database, VIP, SinoMed China Biomedical Literature Service System, PubMed, Cochrane Library and Web of Science. The articles of randomized controlled trials of different drugs for ankylosing spondylitis from inception to September 30, 2020 were collected. EndNote software was used to screen the literature. Cochrane system evaluation and RevMan 5.3 were used to evaluate the quality of the included literature. Network meta-analysis was performed with Stata 14.2.
RESULTS:  A total of 29 randomized controlled trials were included in this study, including 21 high-risk articles and 8 low-risk articles. The control group was treated with sulfasalazine, Yisaipu and thalidomide, while the observation group was treated with Yisaipu, etanercept, thalidomide, sulfasalazine combined with Yisaipu, thalidomide combined with Yisaipu, thalidomide combined with sulfasalazine and etanercept combined with sulfasalazine. The network meta-analysis results showed that the total clinical effective rates were as follows: treatment with Yisaipu combined with thalidomide (OR=0.07, 95%CI:0.03-0.17, P < 0.05),  treatment with Yisaipu (OR=0.23, 95%CI:0.13-0.40, P < 0.05) and treatment with Yisaipu combined with sulfasalazine (OR=0.18, 95%CI:0.10-0.33, P < 0.05) were better than sulfasalazine treatment. The overall effective rate was ranked as: Yisaipu + thalidomide treatment (97.0%) > sulfasalazine + Yisaipu treatment (67.7%) > thalidomide + sulfasalazine treatment (60.0%) > Yisaipu treatment (52.2%) > etanercept + sulfasalazine treatment (47.9%) > etanercept treatment (45.4%) > thalidomide treatment (29.7%) > sulfasalazine treatment (0.2%). (2) The incidence of adverse reactions induced by Yisaipu (OR=0.21, 95%CI:0.05-0.81, P < 0.05) and thalidomide (OR=0.32, 95%CI:0.17-0.61, P < 0.05) was lower than that induced by sulfasalazine. The incidence of adverse reactions from high to low was: etanercept (91.8%) > sulfasalazine (84.8%) > etanercept combined with sulfasalazine (58.8%) > sulfasalazine + Yisaipu (44.5%) > Yisaipu + thalidomide (32.3%) > thalidomide (24.9%) > Yisaipu (12.9%).  
CONCLUSION: Based on the results of 29 randomized controlled trials of different drugs in the treatment of ankylosing spondylitis, in terms of improving clinical efficacy and reducing adverse reactions, Yisaipu combined with thalidomide can be used as the first choice of drug treatment, while Yisaipu alone can be used as the secondary choice of drug treatment.

Key words: ankylosing spondylitis, sulfasalazine, etanercept, Yisaipu, thalidomide, combination medication, randomized controlled trials, network meta-analysis

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