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

Zhiyong Long; Liuting Zeng; Kailin Yang; Junpeng Chen; Yanfang Luo; Charles C Dai; Qi He; Ying Deng; Anqi Ge; Xiaofei Zhu; Wensa Hao; Lingyun Sun

doi:10.3389/fphar.2024.1440584

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

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

Authors

Zhiyong Long^#¹, Liuting Zeng^#², Kailin Yang^#^{3

4}, Junpeng Chen^#^{4

5

6}, Yanfang Luo^#⁷, Charles C Dai^{8

9}, Qi He¹⁰, Ying Deng¹⁰, Anqi Ge³, Xiaofei Zhu¹¹, Wensa Hao¹², Lingyun Sun²

Affiliations

¹ Department of Physical Medicine and Rehabilitation, The Affiliated Panyu Central Hospital, Guangzhou Medical University, Guangzhou, China.
² Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China.
³ Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China.
⁴ Psychosomatic Laboratory, Department of Psychiatry, Daqing Hospital of Traditional Chinese Medicine, Daqing, China.
⁵ Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, United States.
⁶ Tong Jiecheng Studio, Hunan University of Science and Technology, Xiangtan, China.
⁷ The Central Hospital of Shaoyang, Shaoyang, China.
⁸ Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, Baltimore, MD, United States.
⁹ Fischell Department of Bioengineering, A.James Clark School of Engineering, University of Maryland, College Park, MD, United States.
¹⁰ People's Hospital of Ningxiang City, Ningxiang, China.
¹¹ Fudan University, Shanghai, China.
¹² Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

^# Contributed equally.

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.

Publication types

Systematic Review

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.