Effect of TNF‐inhibitor therapy on spinal structural progression in ankylosing spondylitis patients: A systematic review and meta‐analysis
Notice bibliographique
Résumé
Abstract To review the effect of tumor necrosis factor‐alpha inhibitor (TNFi) therapies on radiographic progression in ankylosing spondylitis (AS) patients as evaluated by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from inception to August 2019. All comparative and non‐comparative studies that evaluated the clinical effectiveness of TNFi on radiographic progression as assessed by mSASSS change at a minimum follow‐up of 1 year were included. The Newcastle–Ottawa Scale and Cochrane Collaboration Risk of Bias Tool were utilized to assess the methodological quality. Pooled analysis was performed for continuous and binomial variables where appropriate. Inter‐rater reliability of mSASSS status and change scores were assessed with intra‐class coefficients (ICC). Twenty‐one studies were identified with a total of 4460 patients (mean age: 40.4 years [range 25.3‐50 years]; 76% male; mean baseline mSASSS: 12.7 units [range 5.5‐19.8 units]). All studies (3 randomized and 18 observational studies) were considered to have moderate‐to‐high methodological quality. The inter‐rater reliability of mSASSS status and change scores from 14 of the 21 studies were excellent (ICC ranges, 0.91‐0.99) and moderate‐to‐excellent (ICC ranges, 0.58‐0.90), respectively. From the 21 studies, 11/21 (50%) demonstrated a delayed effect in mSASSS in AS patient administered TNFi. When stratifying these studies into those with ≤4 years of follow‐up and >4 years follow‐up, 3/11 (27%) and 8/10 (80%) studies respectively indicated a delayed effect of mSASSS with TNFi in AS patients. Pooling for meta‐analysis from 3 studies (1159 patients) with study durations ranging 4‐8 years, indicated that TNFi‐treated patients had reduced odds of structural progression (odds ratio 0.81; 95% CI 0.68‐0.96; P = .01; I 2 = 0%). Mean rate of mSASSS change from 16 studies ranged from −0.15 to 7.3 mSASSS units for all AS patients. Meta‐analysis indicated a numerical, but statistically non‐significant, reduction in the rate of mSASSS change with TNFi treatment (7 studies [1438 patients]; mean difference, −0.24; 95% CI, −0.49‐0.01; P = .06; I 2 = 0%). This systematic review and meta‐analysis indicated that >4 years of TNFi usage was associated with delayed structural progression by mSASSS. The narrative analysis of the data from 21 studies further confirmed that studies with >4 years of follow‐up had delayed structural progression with TNFi use in AS patients. The systematic review also confirmed that mSASSS has good‐to‐excellent inter‐rater reliability in AS.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,007 | 0,002 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».