Muthu S, Jeyaraman M, Ranjan R, Jha SK. Remission is not maintained over 2 years with hematopoietic stem cell transplantation for rheumatoid arthritis: A systematic review with meta-analysis. World J Biol Chem 2021; 12(6): 114-130 [PMID: 34904049 DOI: 10.4331/wjbc.v12.i6.114]
Corresponding Author of This Article
Sathish Muthu, MS, Research Scholar, School of Engineering and Technology, Sharda University, Greater Noida, Delhi 201306, Uttar Pradesh, India. drsathishmuthu@gmail.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sathish Muthu, Madhan Jeyaraman, Saurabh Kumar Jha, Department of Biotechnology, School of Engineering and Technology, Sharda University, Delhi 201306, Uttar Pradesh, India
Sathish Muthu, Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
Madhan Jeyaraman, Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Chennai 600095, Tamil Nadu, India
Rajni Ranjan, Department of Orthopaedics, School of Medical Sciences and Research, Greater Noida 201306, Uttar Pradesh, India
Author contributions: Muthu S and Jeyaraman M provide the conceptualization; Muthu S, Jeyaraman M, and Ranjan R contributed to the data curation, formal analysis, investigations, methodology; Muthu S and Ranjan R contributed to the administration, resources, and supervision; Muthu S contributed to the validation and visualization; Muthu S and Jeyaraman M contributed to writing the original draft and reviewing the drafts.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sathish Muthu, MS, Research Scholar, School of Engineering and Technology, Sharda University, Greater Noida, Delhi 201306, Uttar Pradesh, India. drsathishmuthu@gmail.com
Received: March 30, 2021 Peer-review started: March 30, 2021 First decision: May 12, 2021 Revised: May 21, 2021 Accepted: November 26, 2021 Article in press: November 26, 2021 Published online: November 27, 2021 Processing time: 258 Days and 17.8 Hours
ARTICLE HIGHLIGHTS
Research background
Hematopoietic stem cell (HSC) transplantation (HSCT) has been accepted as a treatment method in the management of various inflammatory diseases. With the evolution in the management of rheumatoid arthritis (RA), and the rising resistance to the traditional disease-modifying anti-rheumatic drugs, researchers are in pursuit of alternate methods for disease management. Having the ultimate goal of achieving systemic immune tolerance, HSCT has now been considered in the management of RA with respect to its reparative, paracrine, and anti-inflammatory properties.
Research motivation
Despite the understanding of the potential of HSCT towards immune reconstitution, considering RA to be an auto-immune disease, a systematic review of studies on utilization of HSCs in RA is lacking. If HSCT proves to be useful in refractory cases of RA, future studies to strengthen the evidence on the same could be recommended.
Research objectives
To investigate the role of HSCT in the management of RA.
Research methods
A detailed search of PubMed, Scopus, EMBASE, Cochrane, and the Web of Science databases was made to identify the relevant articles till September 2020 following Cochrane and PRISMA guidelines. All the studies included were analyzed to evaluate the role of HSCT in RA by dichotomizing their outcome based on American College of Rheumatology (ACR) criteria for success (ACR 50/70) and failure (ACR 20) based on the improvement from baseline characteristics. The methodological quality of the included studies was also assessed. Analysis was performed using OpenMeta [Analysis] software.
Research results
Upon meta-analysis of the 17 included studies on the use of HSCT for refractory cases of RA, it was noted that remission was maintained for 2 years. However, for the implementation of the intervention into routine clinical practice, further studies are needed to shed some light on the ideal source of the HSCs for transplantation, the ideal conditioning regimen to be utilized, and the ideal timing of transplantation to reap the maximum benefit it.
Research conclusions
Utilization of HSCT in RA cases that are refractory to the conventional line of management maintained remission to a maximum of 2 years. With the rise in the resistance to traditional therapy for RA, earlier identification of those non-responders based on clinic-serological profile and prognostic markers remains a key element to reap the maximum benefit out of this modality.
Research perspectives
Before the inclusion of HSCT into the routine management protocol for RA, certain questions need further exploration to standardize the treatment protocol to harness maximum benefits out of the procedure.
