Main Article Content
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that symmetrically damages the synovial membrane, affecting approximately thirteen percent of the global population. Systemic complications and substantial declines in quality of life may ensue from untreated RA. This study investigates the safety and efficacy of moxibustion and ozoralizumab in reducing disease activity scores in RA patients. Between July and November 2023, we performed an extensive search across four online databases (PubMed, Cochrane, Scopus, and ProQuest) utilizing keywords, reference searches, and other methodologies in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The obtained randomized controlled trials (RCTs) have been assessed using the Cochrane Risk of Bias 2 Risk of Bias Tools (ROB2). MetaInsight version 5.2.1 was employed to conduct this indirect network meta-analysis, which employed mean difference (MD) as summary statistics. This study demonstrated that ozoralizumab had a more significant effect on rheumatoid arthritis than placebo, as measured by DAS28 (MD=-1.88; 95% CI -2.24-(-1.52)) and moxibustion (MD=-0.69; 95% CI=-1.07-0.31). Ozoralizumab exhibited mild, moderate, and severe side effects, whereas moxibustion exhibited modest side effects compared to the placebo. In summary, ozoralizumab and moxibustion decreased DAS28 scores in rheumatoid arthritis patients, with ozoralizumab being the more effective treatment. Nevertheless, the adverse effects of ozoralizumab were more diverse than those of moxibustion.
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References
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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. https://doi.org/10.5114/reum.2021.110611
- Volkov, M., Schie, K. A., & Woude, D. (2020). Autoantibodies and B Cells: The ABC of rheumatoid arthritis pathophysiology. Immunological Reviews, 294(1), 148–163. https://doi.org/10.1111/imr.12829
- 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 erythrocyte sedimentation rate. Ann. Rheum. Dis. 68, 954–960. https://doi.org/10.1136/ard.2007.084459
- World Health Organization: WHO, (2022). Musculoskeletal health [WWW Document]. URL https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
- Yu, Z., Wang, Y., Li, Y., et al (2020). Effect of Moxibustion on the Serum Levels of MMP-1, MMP-3, and VEGF in Patients with Rheumatoid Arthritis. Evid. Based Complement. Alternat. Med. 2020, 1–9. https://doi.org/10.1155/2020/7150605
- 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. Evid. Based Complement. Alternat. Med. 2020, 1–12. https://doi.org/10.1155/2020/6108619
References
Alivernini, S., Tolusso, B., Petricca, L., et al (2019). Rheumatoid Arthritis, in: Mosaic of Autoimmunity. Elsevier, pp. 501–526. https://doi.org/10.1016/B978-0-12-814307-0.00046-3
Deng, H., Shen, X., 2013. The Mechanism of Moxibustion: Ancient Theory and Modern Research. Evid. Based Complement. Alternat. Med. 2013, 1–7. https://doi.org/10.1155/2013/379291
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 Res. Manag. 2019, 1–9. https://doi.org/10.1155/2019/4705247
Hidayat, R., Suryana, B.P.P., Wijaya, et al (2021). Diagnosis dan Pengelolaan Artritis Reumatoid, Rekomendasi Perhimpunan Reumatologi Indonesia 2021. ed. Perhimpunan Reumatologi Indonesia.
Higgins, J., Thomas, J., Chandler, J., et al (2022). Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane. www.training.cochrane.org/handbook
Kerschbaumer, A., Sepriano, A., Smolen, J.S., 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. Ann. Rheum. Dis. 79, 744–759. https://doi.org/10.1136/annrheumdis-2019-216656
Kiefer, C., Sturtz, S., Bender, R., (2015). Indirect Comparisons and Network Meta-Analyses. Dtsch. Ärztebl. Int. https://doi.org/10.3238/arztebl.2015.0803
Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan, n.d. Laporan Nasional Riskesdas 2018 - Repositori Badan Kebijakan Pembangunan Kesehatan [WWW Document]. URL https://repository.badankebijakan.kemkes.go.id/id/eprint/3514
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. J. Pain Res. Volume 16, 1739–1749. https://doi.org/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(3), 183–191. https://doi.org/10.5114/reum.2022.117838
Page, M.J., McKenzie, J.E., Bossuyt, P.M., et al (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ n71. https://doi.org/10.1136/bmj.n71
Patidar, V., Shah, S., Kumar, R., et al (2022). A molecular insight of inflammatory cascades in rheumatoid arthritis and anti-arthritic potential of phytoconstituents. Mol. Biol. Rep. 49, 2375–2391. https://doi.org/10.1007/s11033-021-06986-7
Pisaniello, H.L., Whittle, S.L., 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 Rheumatol. 6, 67. https://doi.org/10.1186/s41927-022-00299-3
Savitri, S. A., Kartidjo, P., Rahmadi, A. R., & Vikasari, S. N. (2019). Hubungan Pemilihan Obat dan Keberhasilan Terapi Pasien Rheumatoid Arthritis. Indonesian Journal of Clinical Pharmacy, 8(4), 237. https://doi.org/10.15416/ijcp.2019.8.4.237
Shen, B., Sun, Q., Chen, H., Li, Y., Du, X., Li, H., & Xu, G. (2019). Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis: A meta-analysis. Medicine, 98(30), e16413. https://doi.org/10.1097/MD.0000000000016413
Takeuchi, T., 2023. Structural, nonclinical, and clinical features of ozoralizumab: A novel tumour necrosis factor inhibitor. Mod. Rheumatol. road038. https://doi.org/10.1093/mr/road038
Takeuchi, T., Kawanishi, M., Nakanishi, 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 Rheumatol. 74, 1776–1785. https://doi.org/10.1002/art.42273
Tanaka, Y., Kawanishi, M., Nakanishi, M., et al (2022). 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). Mod. Rheumatol. roac119. https://doi.org/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. Pain Res. Manag. 2021, 1–10. https://doi.org/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. https://doi.org/10.5114/reum.2021.110611
Volkov, M., Schie, K. A., & Woude, D. (2020). Autoantibodies and B Cells: The ABC of rheumatoid arthritis pathophysiology. Immunological Reviews, 294(1), 148–163. https://doi.org/10.1111/imr.12829
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 erythrocyte sedimentation rate. Ann. Rheum. Dis. 68, 954–960. https://doi.org/10.1136/ard.2007.084459
World Health Organization: WHO, (2022). Musculoskeletal health [WWW Document]. URL https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Yu, Z., Wang, Y., Li, Y., et al (2020). Effect of Moxibustion on the Serum Levels of MMP-1, MMP-3, and VEGF in Patients with Rheumatoid Arthritis. Evid. Based Complement. Alternat. Med. 2020, 1–9. https://doi.org/10.1155/2020/7150605
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. Evid. Based Complement. Alternat. Med. 2020, 1–12. https://doi.org/10.1155/2020/6108619