A Systematic Review Of Efficacy And Safety Of Tocilizumab Combined With Methotrexate For Treating Rheumatoid Arthritis

Objective: To evaluate the efficacy and safety of tocilizumab(TCZ)combined with methotrexate(MTX)in the treatment of rheumatoid arthritis(RA).Methods: A systematic literature search was performed,using PubMed,Embase,Web of Science,Cochrane Library,Weipu database,CBM,Wanfang database,EU-clinical trials,US-clinical trials and WHO-clinical trials.Two researchers independently selected the literatures,evaluated the quality,and extracted data.The Cocharane collaboration's Review manager 5.3 software was used for data analysis.According to the different doses of tocilizumab,the subgroup analysis compared the effects of tombuzumab 4mg.kg-1 and 8mg.kg-1 on outcome measures.Result: The study included seventeen RCTs.Meta-analysis shows:(1)Efficacy:tocilizumab combined with methotrexate in treatment of RA were superior to methotrexate in ACR20?ACR50?ACR70?EULAR clinical curative effect standard evaluation index,DSA 28 and so on.However,as time goes by(> 104 weeks),there was no significant difference in ACR90,HAQ score,and VSA between the two groups(P> 0.05).(2)Safety:For the overall incidence of serious adverse events,tocilizumab combined with methotrexate increased risk at 8 weeks,20 weeks,24 weeks,and 52 weeks,especially in infection and cardiovascular events.With the extension of the medication time,as for the incidence of serious adverse events,tocilizumab combined with methotrexate group was higher than the methotrexate group at the time of 260 weeks.The incidence of adverse events of group with tocilizumab 8mg.kg-1 was higher than that of tocilizumab 4mg.kg-1,especially in infection,digestive and neurological events.Conclusion: Preliminary analysis showed that tocilizumab combined with methotrexate improved the treatment of RA,and significantly improved the ACR,EULAR clinical curative effect standard evaluation index and the DSA 28 score.As the efficacy oflong-term combination therapy was inaccurate,it significantly increased the incidence of adverse events in the digestive system,cardiovascular system,and infection.Therefore,the selection should be careful.For long-term combination patients with adverse events,especially infection,digestive and nervous system adverse events,reducing the dose of tocilizumab was an effective method,which provided the basis for the application of tocilizumab in patients with RA.