单独和结合mycophenolate在患有系统性硬化症相关的间歇性肺部疾病的患者中使用Nintedanib疗法:系统性评论和元分析
Derrick Herman1, Marya Ghazipura2,3,4, Hayley Barnes5,6,7
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio.
Annals of the American Thoracic Society
|September 29, 2023
概括
单独或与mycophenolate结合使用的nintedanib可减缓系统性硬化症相关的间歇性肺病 (SSc-ILD) 的疾病进展. 然而,这两种治疗都增加了胃肠道副作用和治疗中止,证据质量非常低.
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) 是一种渐进的疾病,需要有效的治疗策略.
- 需要临床实践指南来指导SSc-ILD的管理,特别是关于抗纤维菌疗法.
研究的目的:
- 系统地审查和评估有关宁泰达尼布单一治疗与宁泰达尼布和mycophenolate的SSc-ILD组合治疗的文献.
- 评估这些治疗方案在减少疾病进展和管理不良事件方面的疗效和安全性.
主要方法:
- 系统的文献搜索 MEDLINE,EMBASE 和 Cochrane 中央受控试验登记册,截至 2022 年 6 月.
- 包括在SSc-ILD患者中评估宁泰达尼布或宁泰达尼布加mycophenolate的研究.
- 数据提取包括死亡率,疾病进展 (强迫生命能力下降),生活质量和不良事件,并进行元分析和GRADE评估.
主要成果:
- 与安慰剂相比,丁丁达尼布单独治疗显示强迫生命能力 (FVC) 衰退减少,但胃肠道副作用和治疗中止增加了一倍.
- 与宁泰达尼布和mycophenolate的联合治疗表明,FVC下降的减少比安慰剂更大,但也增加了胃肠道不良反应.
- 根据GRADE方法,对所有评估结果的证据质量被评为非常低.
结论:
- 与安慰剂相比,单独使用宁泰达尼布和与甲酸联合使用均可显著降低SSc-ILD的疾病进展.
- 胃肠道副作用的增加和停止治疗与这两种治疗策略有关.
- 证据的质量非常低,需要谨慎地解释研究结果,并进一步进行高质量的研究.
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