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药物管理以减少患有喘的成年人的恶化:系统性审查和元分析
Don D Sin1, Jonathan Man, Heather Sharpe
1James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, University of British Columbia, Vancouver, Canada. dsin@mrl.ubc.ca
JAMA
|July 22, 2004
概括
吸入性皮质类固醇是最有效的喘治疗方法,可显著减少喘恶化. 其他治疗方法,如白细胞基基基因修饰剂和抗IgE,为特定的患者群体提供了替代方案.
科学领域:
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
背景情况:
- 喘发病率有所增加,促使开发新的药理学药物.
- 这些喘药物对恶化频率的长期影响尚不清楚.
研究的目的:
- 系统地审查和综合长期关于吸入性皮质类固醇 (ICS),长效β2激动剂 (LABA),白血素路径修饰剂/受体对抗剂 (LTM/TRA) 和抗IgE疗法的数据.
- 评估这些喘药物对慢性喘成人患者临床结果和恶化的影响.
主要方法:
- 在MEDLINE,EMBASE和Cochrane数据库 (1980-2004) 中进行了全面的文献搜索.
- 包括双盲随机受控试验,随访时间≥3个月,以及有关恶化或FEV1.1的数据.
- 与安慰剂,短效β2激动剂或其他活性治疗方法进行比较分析.
主要成果:
- 吸入性皮质类固醇 (ICS) 显示出最高的疗效,减少了55%的恶化 (RR,0.46;95% CI,0.34-0.62).
- 长效β2激动剂 (LABA) 减少了25%的恶化 (RR,0.75;95% CI,0.64-0.88) 并与ICS结合时显示出额外的益处 (RR,0.74;95% CI,0.61-0.91).
- 乐古特里因修饰剂/受体对抗剂 (LTM/TRA) 减少了41%的恶化 (RR,0.59;95% CI,0.49-0.71),但效果不如ICS.
- 与ICS结合的抗IgE治疗减少了45%的恶化 (RR,0.55;95%CI,0.45-0.66).
结论:
- 吸入性皮质类固醇 (ICS) 是用于控制成人喘恶化最有效的单一疗法.
- 乳三烯修饰剂/受体对抗剂 (LTM/TRA) 是无法或不愿意使用ICS的患者的可行替代品.
- 对于有症状的患者,LABA可以添加到ICS中,而抗IgE疗法是高IgE过敏喘的潜在辅助治疗.
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