Main Article Content
Abstract
Rheumatoid arthritis is a chronic inflammatory disease that symmetrically damages the synovial membrane, affecting approximately 13% of the global population. Systemic complications and substantial declines in quality of life may result from untreated rheumatoid arthritis. This study investigated the safety and efficacy of moxibustion and ozoralizumab in reducing disease activity scores in rheumatoid arthritis patients. Between July 2023 and February 2025, we conducted a thorough search on four online databases (PubMed, Cochrane, Scopus, and ProQuest) using keywords, reference searches, and other methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The obtained randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias 2 (ROB2) tool. MetaInsight version 5.2.1 was utilized to perform the indirect network meta-analysis, using mean difference (MD) as the summary statistics. The measurement of the Disease Activity Score 28 (DAS28) indicated that ozoralizumab had a more significant effect on rheumatoid arthritis compared to placebo (MD=-1.88, 95% CI=-2.24-(-1.52)) and moxibustion (MD=-0.69, 95% CI=-1.07-0.31). Ozoralizumab demonstrated mild, moderate, and severe side effects, whereas moxibustion displayed modest side effects in comparison to placebo. In summary, both ozoralizumab and moxibustion reduced DAS28 in patients with rheumatoid arthritis, with ozoralizumab proving to be the more effective treatment. However, the adverse effects of ozoralizumab were more varied than those of moxibustion.
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References
- Deng H, Shen X (2013). The mechanism of moxibustion: Ancient theory and modern research. Evidence-Based Complementary and Alternative Medicine 2013, 1–7. doi: 10.1155/2013/379291.
- Flemyng E, Moore TH, Boutron I, et al (2023). Using risk of bias 2 to assess results from randomised controlled trials: Guidance from Cochrane. BMJ Evidence-Based Medicine 28, 260–266. doi: 10.1136/bmjebm-2022-112102.
- Gong Y, Yu Z, Wang Y, et al (2019). Effect of moxibustion on HIF-1 α and VEGF levels in patients with rheumatoid arthritis. Pain Research and Management 2019, 1–9. doi: 10.1155/2019/4705247.
- Health Research and Development Agency (2018). National riskesdas report 2018. Available at: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/.
- Hidayat R, Suryana BPP, Wijaya LK, et al. (2021). Diagnosis and management of rheumatoid arthritis. Perhimpunan Reumatologi Indonesia. Available at: https://reumatologi.or.id/rekomenda si-ra-diagnosis-dan-pengelolaan-artritis-reumatoi d/.
- Higgins J, Thomas J, Chandler J, et al (2024). Cochrane handbook for systematic reviews of interventions version 6.5. John Wiley & Sons, Chichester (UK). Available at: https://training.cochrane.org/handbook#how-to-cite.
- Kerschbaumer A, Sepriano A, Smolen JS, et al (2020). Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis. Annals of the Rheumatic Diseases 79, 744–759. doi: 10.1136/annrheumdis-2019-216656.
- Kiefer C, Sturtz S, Bender R (2015). Indirect comparisons and network meta-analyses. Deutsches Ärzteblatt international. doi: 10.3238/arztebl.2015.0803.
- Li T, Puhan MA, Vedula SS, et al (2011). Network meta-analysis-highly attractive but more methodological research is needed. BMC Medicine 9, 79. doi: 10.1186/1741-7015-9-79.
- Liao C, Tao S, Xiong Y, et al (2023). The effects and potential mechanisms of moxibustion for rheumatoid arthritis-related pain: A randomized, controlled trial. Journal of Pain Research 16, 1739–1749. doi: 10.2147/JPR.S408814.
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- Owen RK, Bradbury N, Xin Y, et al (2019). MetaInsight: An interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-shiny and netmeta. Research Synthesis Methods 10, 569-581. doi: doi: 10.1002/jrsm.1373.
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- Pisaniello HL, Whittle SL, Lester S, et al (2022). Using the derived 28-joint disease activity score patient-reported components (DAS28-P) index as a discriminatory measure of response to disease-modifying anti-rheumatic drug therapy in early rheumatoid arthritis. BMC Rheumatology 6, 67. doi: 10.1186/s41927-022-00299-3.
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- Tipsing W, Sawanyawisuth K (2021). Predictive clinical factors in rheumatoid arthritis using disease activity and functional score. Rheumatology 59, 309–312. doi: 10.5114/reum.2021.110611.
- Wells G, Becker J-C, Teng J, et al (2009). Validation of the 28-joint disease activity score (DAS28) and European league against rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythr. Annals of the Rheumatic Diseases 68, 954–960. doi: 10.1136/ard.2007.084459.
- World Health Organization (2022). Musculoskeletal health. WHO. Available at: https://www.who.int /news-room/fact-sheets/detail/musculoskeletal-co nditions.
- Zhong Y, Cheng B-, Zhang L, et al (2020). Effect of moxibustion on inflammatory cytokines in animals with rheumatoid arthritis: A systematic review and meta‐analysis ed. Hu W. Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2020/6108619.
References
Deng H, Shen X (2013). The mechanism of moxibustion: Ancient theory and modern research. Evidence-Based Complementary and Alternative Medicine 2013, 1–7. doi: 10.1155/2013/379291.
Flemyng E, Moore TH, Boutron I, et al (2023). Using risk of bias 2 to assess results from randomised controlled trials: Guidance from Cochrane. BMJ Evidence-Based Medicine 28, 260–266. doi: 10.1136/bmjebm-2022-112102.
Gong Y, Yu Z, Wang Y, et al (2019). Effect of moxibustion on HIF-1 α and VEGF levels in patients with rheumatoid arthritis. Pain Research and Management 2019, 1–9. doi: 10.1155/2019/4705247.
Health Research and Development Agency (2018). National riskesdas report 2018. Available at: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/.
Hidayat R, Suryana BPP, Wijaya LK, et al. (2021). Diagnosis and management of rheumatoid arthritis. Perhimpunan Reumatologi Indonesia. Available at: https://reumatologi.or.id/rekomenda si-ra-diagnosis-dan-pengelolaan-artritis-reumatoi d/.
Higgins J, Thomas J, Chandler J, et al (2024). Cochrane handbook for systematic reviews of interventions version 6.5. John Wiley & Sons, Chichester (UK). Available at: https://training.cochrane.org/handbook#how-to-cite.
Kerschbaumer A, Sepriano A, Smolen JS, et al (2020). Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis. Annals of the Rheumatic Diseases 79, 744–759. doi: 10.1136/annrheumdis-2019-216656.
Kiefer C, Sturtz S, Bender R (2015). Indirect comparisons and network meta-analyses. Deutsches Ärzteblatt international. doi: 10.3238/arztebl.2015.0803.
Li T, Puhan MA, Vedula SS, et al (2011). Network meta-analysis-highly attractive but more methodological research is needed. BMC Medicine 9, 79. doi: 10.1186/1741-7015-9-79.
Liao C, Tao S, Xiong Y, et al (2023). The effects and potential mechanisms of moxibustion for rheumatoid arthritis-related pain: A randomized, controlled trial. Journal of Pain Research 16, 1739–1749. doi: 10.2147/JPR.S408814.
Nasir N, Majid H, Khan A, et al (2022). Disease activity correlates and functionality in patients with rheumatoid arthritis – real-world experience from a South Asian country. Rheumatology 60, 183–191. doi: 10.5114/reum.2022.117838.
Owen RK, Bradbury N, Xin Y, et al (2019). MetaInsight: An interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-shiny and netmeta. Research Synthesis Methods 10, 569-581. doi: doi: 10.1002/jrsm.1373.
Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJn71. doi: 10.1136/bmj.n71.
Pisaniello HL, Whittle SL, Lester S, et al (2022). Using the derived 28-joint disease activity score patient-reported components (DAS28-P) index as a discriminatory measure of response to disease-modifying anti-rheumatic drug therapy in early rheumatoid arthritis. BMC Rheumatology 6, 67. doi: 10.1186/s41927-022-00299-3.
Porritt K, Gomersall J, Lockwood C (2014). JBI’s systematic reviews. AJN, American Journal of Nursing 114, 47–52. doi: 10.1097/01.NAJ.000045 0430.97383.64.
Savitri SA, Kartidjo P, Rahmadi AR, et al (2019). The relationship between drug selection and therapy success in rheumatoid arthritis patients. Indonesian Journal of Clinical Pharmacy 8, 237. doi: 10.15416/ijcp.2019.8.4.237.
Shen B, Sun Q, Chen H, et al (2019). Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis. Medicine (Baltimore) 98, e16413. doi: 10.1097/MD.0000000000016413.
Takeuchi T (2023). Structural, nonclinical, and clinical features of ozoralizumab: A novel tumour necrosis factor inhibitor. Modern Rheumatology 33, 1059–1067. doi: 10.1093/mr/road038.
Takeuchi T, Kawanishi M, Nakanishi M, et al (2022). Phase II/III results of a trial of anti–tumor necrosis factor multivalent NANOBODY compound ozoralizumab in patients with rheumatoid arthritis. Arthritis & Rheumatology 74, 1776–1785. doi: 10.1002/art.42273.
Tanaka Y, Kawanishi M, Nakanishi M, et al (2023). Efficacy and safety of the anti-TNF multivalent NANOBODY® compound ozoralizumab in patients with rheumatoid arthritis and an inadequate response to methotrexate: A 52-week result of a Phase II/III study (OHZORA trial). Modern Rheumatology33, 883–890. doi: 10.1093/mr/roac119.
Tao S, Wang X, Liao C, et al (2021). The efficacy of moxibustion on the serum levels of CXCL1 and β-EP in patients with rheumatoid arthritis ed. Wang X-Q. Pain Research and Management 2021, 1–10. doi: 10.1155/2021/7466313.
Tipsing W, Sawanyawisuth K (2021). Predictive clinical factors in rheumatoid arthritis using disease activity and functional score. Rheumatology 59, 309–312. doi: 10.5114/reum.2021.110611.
Wells G, Becker J-C, Teng J, et al (2009). Validation of the 28-joint disease activity score (DAS28) and European league against rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythr. Annals of the Rheumatic Diseases 68, 954–960. doi: 10.1136/ard.2007.084459.
World Health Organization (2022). Musculoskeletal health. WHO. Available at: https://www.who.int /news-room/fact-sheets/detail/musculoskeletal-co nditions.
Zhong Y, Cheng B-, Zhang L, et al (2020). Effect of moxibustion on inflammatory cytokines in animals with rheumatoid arthritis: A systematic review and meta‐analysis ed. Hu W. Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2020/6108619.