系统性硬化症相关的间歇性肺病患者的环胺:系统性审查和元分析
Hayley Barnes1,2,3, Marya Ghazipura4,5, Derrick Herman6
1Clinical School and.
Annals of the American Thoracic Society
|September 29, 2023
概括
与安慰剂相比,环胺对系统性硬化症相关的间歇性肺病 (SSc-ILD) 有好处,改善呼吸困难和残疾,但增加副作用风险. 甲酸可能会提供类似或更优异的结果,更少的停药.
科学领域:
- 肺部病理学 肺部病理学
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
背景情况:
- 系统性硬化症相关的间歇性肺病 (SSc-ILD) 是需要有效治疗策略的重大并发症.
- 美国胸腔学会制定了临床实践指南,需要对现有疗法进行审查,如环胺.
研究的目的:
- 系统地审查和评估循环胺在治疗SSc-ILD时的疗效和安全性.
- 在SSc-ILD患者中,将环胺与安慰剂和mycophenolate进行比较.
主要方法:
- 在MEDLINE,EMBASE和Cochrane控制试验中央注册册册中进行了全面的文献搜索,截至2022年6月.
- 分析了五项研究,包括随机对照试验和病例对照研究,以分析死亡率,疾病进展,生活质量和不良事件等结果.
- 使用元分析和建议评级,评估,开发和评估 (GRADE) 方法来评估证据的质量.
主要成果:
- 与安慰剂相比,环胺证明了强迫生命能力下降的适度降低,呼吸困难和残疾的显著改善.
- 然而,环胺使用与白血病和宪法症状的风险增加有关,而不会影响死亡率.
- 与mycophenolate相比,环胺对肺部对一氧化碳的扩散能力的影响不那么好,治疗中断率更高.
结论:
- 与安慰剂相比,环胺在SSc-ILD中有效,但具有副作用的风险增加.
- 甲酸似乎是一种替代治疗选择,可能是模两可的或优于环胺,停药率较低.
- 治疗决策应仔细考虑个体患者的情况,偏好以及每个药物的风险-益处概况.
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