JAMA Dermatol:低剂量甲氨蝶呤暴露与黑色素瘤的相关性,系统综述和荟萃分析

2022-09-15 紫菀款冬 MedSci原创

确定甲氨蝶呤暴露是否与皮肤黑色素瘤风险增加相关。

背景:甲氨蝶呤广泛用于治疗炎症性疾病,包括类风湿性关节炎。研究表明,甲氨蝶呤可能与黑色素瘤风险增加有关。

目的:确定甲氨蝶呤暴露是否与皮肤黑色素瘤风险增加相关

数据来源:从研究开始到2022年5月12日,对MEDLINE、Embase、Cochrane临床对照试验资料库和美国临床试验注册库进行了搜索,以获得合格的研究。

研究选择:如果病例对照研究、队列研究或随机临床试验(RCT)检查了暴露于低剂量甲氨蝶呤的个体与未暴露的个体的皮肤黑色素瘤发生率或风险,则纳入这些研究。没有语言限制。

数据提取和综合:两名独立审查员提取了研究特征和结果数据。对流行病学指南中的观察性研究进行荟萃分析。为了评估研究质量,将Cochrane偏倚风险工具用于随机对照试验,JBI检查表用于队列和病例对照研究。收集病例对照研究的优势比和队列研究或随机对照试验的相对风险或危险比,并进行随机效应模型荟萃分析。

主要结果和测量:预先指定的结果是比较低剂量甲氨蝶呤暴露与非暴露的皮肤黑色素瘤的优势比、风险比或风险比。

结果:17项研究(8项随机对照试验、5项队列研究、4项病例对照研究)符合纳入条件,其中12项研究中16642例黑色素瘤纳入初步分析。甲氨蝶呤的适应症包括类风湿性关节炎、银屑病、银屑炎性关节炎和炎症性肠病,在5项研究中未知。

与未接触甲氨蝶呤的个体相比,接触甲氨喋呤的研究参与者患黑素瘤的风险略有增加(合并相对风险,1.15;95%CI,1.08-1.22),但在排除最大研究的敏感性分析中,这一情况并未持续(合并相对危险,1.11;95%CI,1-1.24)。

亚组分析用于对照组(比较甲氨蝶呤或免疫调节剂单独使用和二者联用)或类风湿性关节炎使用甲氨蝶嘧啶的指征提供了类似的风险评估。使用地理人口黑素瘤发病率,在澳大利亚需要18630例用于计算,北美需要41425个。

结论:在该项系统综述和荟萃分析中,低剂量甲氨蝶呤暴露与黑色素瘤风险增加相关,但绝对风险增加可被视为可忽略不计

文献来源:

Yan MK, Wang C, Wolfe R, Mar VJ, Wluka AE. Association Between Low-Dose Methotrexate Exposure and Melanoma: A Systematic Review and Meta-analysis [published online ahead of print, 2022 Aug 31]. JAMA Dermatol. 2022;10.1001/jamadermatol.2022.3337. doi:10.1001/jamadermatol.2022.3337

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    2023-05-15 sunylz
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1838109, encodeId=3b901838109b0, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Wed Jun 07 17:51:04 CST 2023, time=2023-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680830, encodeId=406c1680830ab, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Mon May 15 11:51:04 CST 2023, time=2023-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1837036, encodeId=db4f183e0360f, content=<a href='/topic/show?id=1f188e230c5' target=_blank style='color:#2F92EE;'>#荟萃分析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87230, encryptionId=1f188e230c5, topicName=荟萃分析)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=fangcong, createdTime=Mon Dec 26 11:51:04 CST 2022, time=2022-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1681484, encodeId=ec271681484bd, content=<a href='/topic/show?id=366b8e2299e' target=_blank style='color:#2F92EE;'>#荟萃#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87229, encryptionId=366b8e2299e, topicName=荟萃)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c12d27855367, createdName=venlin, createdTime=Thu Jan 26 18:51:04 CST 2023, time=2023-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1971870, encodeId=8a2319e18706f, content=<a href='/topic/show?id=8299e694421' target=_blank style='color:#2F92EE;'>#系统综述#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76944, encryptionId=8299e694421, topicName=系统综述)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Aug 17 12:51:04 CST 2023, time=2023-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1480644, encodeId=1d631480644c9, content=<a href='/topic/show?id=647d2615939' target=_blank style='color:#2F92EE;'>#低剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26159, encryptionId=647d2615939, topicName=低剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97b17641126, createdName=ms1292405679162969, createdTime=Thu Sep 15 15:51:04 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1559154, encodeId=60af15591540d, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Thu Sep 15 15:51:04 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565163, encodeId=fa071565163ff, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Thu Sep 15 15:51:04 CST 2022, time=2022-09-15, status=1, ipAttribution=)]
    2023-01-26 venlin
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