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. 2024 Oct 10:15:1440584.
doi: 10.3389/fphar.2024.1440584. eCollection 2024.

A systematic review and meta-analysis of the efficacy and safety of iguratimod in the treatment of inflammatory arthritis and degenerative arthritis

Zhiyong Long #  1 , Liuting Zeng #  2 , Kailin Yang #  3   4 , Junpeng Chen #  4   5   6 , Yanfang Luo #  7 , Charles C Dai  8   9 , Qi He  10 , Ying Deng  10 , Anqi Ge  3 , Xiaofei Zhu  11 , Wensa Hao  12 , Lingyun Sun  2
Affiliations

A systematic review and meta-analysis of the efficacy and safety of iguratimod in the treatment of inflammatory arthritis and degenerative arthritis

Zhiyong Long et al. Front Pharmacol. .

Abstract

Objective: To assess the efficacy and safety of iguratimod (IGU) in the treatment of inflammatory arthritis and degenerative arthritis.

Methods: Initially, randomized controlled trials (RCTs) on using IGU in treating inflammatory arthritis and degenerative arthritis were systematically gathered from various databases up to February 2024. Subsequently, two researchers independently screened the literature, extracted data, assessed the risk of bias in included studies, and conducted a meta-analysis using RevMan 5.4 software.

Results: Fifty-four RCTs involving three inflammatory arthritis were included, including ankylosing spondylitis (AS), osteoarthritis (OA), and rheumatoid arthritis (RA). For AS, the meta-analysis results showed that IGU may decrease BASDAI (SMD -1.68 [-2.32, -1.03], P < 0.00001) and BASFI (WMD -1.29 [-1.47, -1.11], P < 0.00001); IGU may also decrease inflammatory factor [ESR: (WMD -10.33 [-14.96, -5.70], P < 0.0001); CRP: (WMD -10.11 [-14.55, -5.66], P < 0.00001); TNF-α: (WMD -6.22 [-7.97, -4.47], P < 0.00001)]. For OA, the meta-analysis results showed that IGU may decrease VAS (WMD -2.20 [-2.38, -2.01], P < 0.00001) and WOMAC (WMD -7.27 [-12.31, -2.24], P = 0.005); IGU may also decrease IL-6 (WMD -8.72 [-10.00, -7.45], P < 0.00001). For RA, the meta-analysis results showed that IGU may improve RA remission rate [ACR20: (RR 1.18 [1.02, 1.35], P = 0.02); ACR50: (RR 1.32 [1.05, 1.64], P = 0.02); ACR70: (RR 1.44 [1.02, 2.04], P = 0.04)] and decrease DAS28 (WMD -0.92 [-1.20, -0.63], P < 0.00001); IGU may also decrease inflammatory factors [CRP: (SMD -1.36 [-1.75, -0.96], P < 0.00001); ESR: (WMD -9.09 [-11.80, -6.38], P < 0.00001); RF: (SMD -1.21 [-1.69, -0.73], P < 0.00001)]. Regarding safety, adding IGU will not increase the incidence of adverse events.

Conclusion: IGU might emerge as a promising and secure therapeutic modality for addressing AS, OA, and RA.

Systematic review registration: Identifier PROSPERO: CRD42021289249.

Keywords: degenerative arthritis; iguratimod; inflammatory arthritis; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of clinical literature searching and results screening.
FIGURE 2
FIGURE 2
Risk of bias graph.
FIGURE 3
FIGURE 3
Risk of bias summary.
FIGURE 4
FIGURE 4
The results of BASDAI.
FIGURE 5
FIGURE 5
The results of BASFI.
FIGURE 6
FIGURE 6
The results of ESRs.
FIGURE 7
FIGURE 7
The results of CRP.
FIGURE 8
FIGURE 8
The results of TNF-α
FIGURE 9
FIGURE 9
Adverse events.
FIGURE 10
FIGURE 10
VAS.
FIGURE 11
FIGURE 11
WOMAC.
FIGURE 12
FIGURE 12
TNF-α.
FIGURE 13
FIGURE 13
IL-6.
FIGURE 14
FIGURE 14
ACR20.
FIGURE 15
FIGURE 15
ACR50.
FIGURE 16
FIGURE 16
ACR70.
FIGURE 17
FIGURE 17
DAS28.
FIGURE 18
FIGURE 18
CRP.
FIGURE 19
FIGURE 19
ESR.
FIGURE 20
FIGURE 20
RF.
FIGURE 21
FIGURE 21
Adverse events for RA.
FIGURE 22
FIGURE 22
The molecular mechanism of IGU in treating inflammatory arthritis.
See this image and copyright information in PMC

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