In a groundbreaking systematic review and meta-analysis, researchers revealed compelling evidence supporting the efficacy and safety profile of iguratimod (IGU) in treating ankylosing spondylitis (AS). The study, which analyzed data from 10 randomized controlled trials encompassing 622 patients, provided new insights into this multi-targeted disease-modifying antirheumatic drug (DMARD).
The meta-analysis highlighted statistically significant improvements in several clinical measures. IGU appeared to reduce Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores (SMD -1.62), Bath Ankylosing Spondylitis Functional Index (BASFI) scores (WMD -1.30), and Visual Analog Scale (VAS) scores (WMD -2.01), indicating a possible role in decreasing AS-related disease activity, improving functionality, and alleviating pain. Though the quality of evidence for these outcomes was categorized as low or very low, the findings are noteworthy for specialists looking to optimize AS care. Safety concerns were also addressed in the study, revealing that IGU did not significantly increase adverse events when combined with standard AS therapies. The relative risk (RR) for adverse events was 0.65, and the evidence quality was moderate, suggesting that IGU may offer a favorable safety profile in combination treatments.
IGU is a novel small-molecule anti-rheumatic drug recognized for its efficacy and favorable safety profile in treating active rheumatoid arthritis. Its therapeutic effects stem from its dual action on both T and B lymphocytes. IGU effectively suppresses the expression of various inflammatory factors, inhibits B cells from producing immunoglobulins and autoantibodies, downregulates T-cell-mediated cellular immunity, and accelerates bone formation. Additionally, it has shown activity against pulmonary fibrosis. In recent years, IGU has been increasingly used to manage various rheumatic diseases, including Sjögren’s syndrome, ankylosing spondylitis, and systemic lupus erythematosus. IGU’s mechanisms include inhibiting inflammation-related pathways (e.g., NF-kB and IL-17), blocking osteoclast differentiation via the RANKL pathway, enhancing osteoblast function through the BMP/Dlx5/Osterix pathway, and reducing cartilage damage by regulating MMP family factors, thus contributing to bone protection.
The findings suggest that IGU could serve as a valuable addition to AS management, potentially expanding therapeutic options for patients unresponsive to conventional therapies. The evidence underscores IGU’s potential as a multi-targeted DMARD, which may benefit rheumatologists considering alternative strategies for managing AS symptoms and improving patient quality of life. As new therapies continue to emerge, the results of this systematic review and meta-analysis encourage further research into IGU’s long-term benefits and role within comprehensive AS treatment protocols.
For comprehensive details on Iguratimod and its clinical applications in rheumatology, please refer to the following link: https://rheumatv.com/iguratimod-clinical-use-in-rheumatology-safety-concern-precautions-management-of-adverse-events/
References
- Long Z, Deng Y, He Q, Yang K, Zeng L, Hao W, Deng Y, Fan J, Chen H. Efficacy and safety of Iguratimod in the treatment of Ankylosing Spondylitis: A systematic review and meta-analysis of randomized controlled trials. Front Immunol. 2023 Mar 3;14:993860.
- Jiang H, Gao H, Wang Q, Wang M, Wu B. Molecular mechanisms and clinical application of Iguratimod: A review. Biomed Pharmacother. 2020 Feb;122:109704.