Safety and efficacy of immunoadsorption therapy for rheumatoid arthritis: a network meta-analysis and systematic review

doi:10.12307/2026.053

Abstract

Abstract: OBJECTIVE: To evaluate the efficacy and safety of different immunosorbent columns in the treatment of rheumatoid arthritis through a network meta-analysis, and provide evidence-based basis for clinical diagnosis and treatment.
METHODS: By computer, the databases of VIP, WanFang, CNKI, PubMed, CBM, CochraneLibrary, and Web of Science were searched for published cohort studies of immunosorbent column for the treatment of rheumatoid arthritis, with a time limit until August 2024. The quality of the included randomized controlled trials was assessed using the Cochrane5.4 manual. The quality of retrospective cohort studies were evaluated via the Newcastle-Ottawa Scale (NOS). Bayesian network meta-analysis was performed using R4.1.1 software.
RESULTS: A total of 13 studies were included, with a total sample size of 891 cases, and 4 immunosorbent columns were included. The results of the network meta-analysis showed that the top three orders that reduce C-reactive protein level: HA280 adsorption column + conventional Western medicine > PH-350 adsorption column + conventional Western medicine > A protein adsorption column; the top three orders that reduce erythrocyte sedimentation rates: leukocyte adsorption column > HA280 adsorption column + conventional Western medicine > PH-350 adsorption column + conventional western medicine; the top three orders that reduce swollen joint count: leukocyte adsorption column > A protein adsorption column + conventional western medicine > PH-350 type adsorption column + conventional Western medicine; the top three orders that reduce tenderness joint counts: leukocyte adsorption column > A protein adsorption column + conventional western medicine > PH-350 adsorption column + conventional Western medicine; the top three orders that reduce patients' disease activity evaluation: PH-350 adsorption column + conventional western medicine > leukocyte adsorption column > A protein adsorption column; the top three orders that reduce visual analogue scale scores: PH-350 adsorption column + conventional Western medicine > A protein adsorption column > leukocyte adsorption column; the top three orders that reduce physician’s disease activity assessment: PH-350 adsorption column + conventional Western medicine > leukocyte adsorption column > conventional Western medicine.
CONCLUSION: Based on the 13 articles, in terms of reducing C-reactive protein level, HA280 adsorption column and conventional Western medicine are the preferred choice. In terms of reducing erythrocyte sedimentation rate, swollen joint count, and tender joint count, leukocyte adsorption column is the preferred choice. In terms of reducing patient’s disease activity evaluation, physician’s disease activity evaluation and visual analogue scale scores, PH-350 adsorption column and conventional Western medicine are the first choice. Different immunosorbent columns can be reasonably and accurately selected according to the patient’s specific conditions.

Key words: rheumatoid arthritis, absorption column, immunosorbent column, immunosorbent method, Bayesian model, network meta-analysis

CLC Number:

Zheng Yin, Wu Zhenhua, Zhang Cheng, Ruan Kexin, Gang Xiaolin, Ji Hong. Safety and efficacy of immunoadsorption therapy for rheumatoid arthritis: a network meta-analysis and systematic review[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(5): 1260-1268.

Figures/Tables 8

2.2 纳入研究的基本特征与偏倚风险评价结果纳入13项研究[8-20]，总样本量891例，均为双臂试验研究。8项研究报告了C-反应蛋白[8-10，12-14，16，19]，7项研究报告了红细胞沉降率[8-11，16，19-20]，12项研究报告了肿胀关节计数[8，10-20]，10项研究报告了压痛关节计数[10-15，17-20]，6项研究报告了患者对疾病活动性评价与医师对疾病活动性评价[10-14，20]，7项研究报告了目测类比评分[9，14-20]；而随机对照试验偏倚风险方面，8篇文献说明了具体的随机方法[9，11-15，17-18]，5篇文献采取了密封信封抽取[9，11-14]，5篇文献采取了双盲[9，11-14]，纳入的所有文献均未说明结局的盲法评价，故视为风险不明，数据不完整性为低风险，其他偏倚风险和选择性报告均为不明。而回顾性队列研究偏倚风险显示，结果均大于7分。纳入研究的基本特征见表1，随机对照试验偏倚风险评价见图3。队列研究的偏倚风险评价结果见表2。 2.3 收敛性评价与证据网络对C-反应蛋白、红细胞沉降率、关节肿胀计数、关节压痛计数、患者对疾病活动性评价、医师对疾病活动性评价、目测类比评分 7项指标分别进行一致性分析，得出潜在尺度缩减因子均< 1.1，说明模型收敛性良好，故在一致性模型情况下进行网状Meta分析。纳入的研究共包括9种治疗措施，分别是A：A蛋白吸附柱；B：安慰组；C：白细胞吸附柱；D：HA280型吸附柱；E：西药常规治疗；F：PH-350型吸附柱；AE：A蛋白吸附柱联合常规西药治疗；DE：HA280型吸附柱联合常规西药治疗；FE：PH-350型吸附柱联合常规西药治疗。图4中圆圈代表各干预措施，圆圈大小代表样本量，直线的粗细代表两干预措施的研究数量，两点间的连线表示两种干预间进行直接比较的关系，该研究共包括4种免疫吸附柱，免疫吸附柱之间均无直接比较的依据，运用网状Meta分析比较间接疗效。 2.4 网状Meta分析结果与异质性检验结果 ①在降低C-反应蛋白方面，HA280型吸附柱＋常规西药优于常规西药；②在降低红细胞沉降率方面，白细胞吸附柱优于安慰组；③在降低关节肿胀计数方面，A蛋白吸附柱＋常规西药、白细胞吸附柱、HA280型吸附柱＋常规西药、PH-350型吸附柱＋常规西药均优于常规西药，A蛋白吸附柱＋常规西药、白细胞吸附柱、HA280型吸附柱＋常规西药、常规西药、PH-350型吸附柱＋常规西药均优于A蛋白吸附柱和安慰组，白细胞吸附柱要优于HA280型吸附柱＋常规西药；④在降低关节压痛计数方面，A蛋白吸附柱＋常规西药优于常规西药，A蛋白吸附柱＋常规西药、"

柱＋常规西药(FE)>A蛋白吸附柱(A)>安慰组(B)>白细胞吸附柱(C)>常规西药(E)；②在降低红细胞沉降率方面：白细胞吸附柱(C)>HA280型吸附柱＋常规西药(DE)>PH-350型吸附柱＋常规西药(FE)>安慰组(B)>常规西药(E)；③在降低关节肿胀计数方面：白细胞吸附柱(C)>A蛋白吸附柱＋常规西药(AE)>PH-350型吸附柱＋常规西药(FE)>HA280型吸附柱＋常规西药(DE)>常规西药(E)>A蛋白吸附柱(A)>安慰组(B)；④在降低关节压痛计数方面：白细胞吸附柱(C)>A蛋白吸附柱＋常规西药(AE)>PH-350型吸附柱＋常规西药(FE)>HA280型吸附柱＋常规西药(DE)>常规西药(E)>A蛋白吸附柱(A)>安慰组(B)；⑤在降低患者对疾病活动性评价方面：PH-350型吸附柱＋常规西药(FE)>白细胞吸附柱(C)>A蛋白吸附柱(A)>安慰组(B)>常规西药(E)；⑥在降低目测类比评分方面：PH-350型吸附柱＋常规西药(FE)>A蛋白吸附柱(A)>白细胞吸附柱(C)>安慰组(B)>常规西药(E)；⑦在降低医师对疾病活动性评价方面：PH-350型吸附柱＋常规西药(FE)>白细胞吸附柱(C)>常规西药(E)>A蛋白吸附柱(A)>安慰组(B)，见图6。 2.6 不一致性检验不一致性检验是利用节点拆分法检验直接证据与间接证据间结果是否一致，所有结局指标的证据网络图均未形成闭环结构，即缺少直接证据，故未作一致性检验。 2.7 发表偏倚对关节肿胀计数、关节压痛计数进行小样本检测，从图7可见各研究大多分布于中上部，但左右对称性较差，提示有发表偏倚的风险。 2.8 不良反应事件 13篇文章中，10篇描述了不良反应事件[8，11-14，16-20]，见表4，其中HA280型吸附柱联合常规西药的不良事件率为15%，白细胞吸附柱的不良事件率为8.3%，PH-350型吸附柱联合常规西药的不良事件率为9.4%，A蛋白吸附柱的不良反应事件率为28.1%。"

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