对他类药物的不耐受性再挑战:随机对照试验的系统审查和元分析
Roni Kraut1, Faith Wierenga2, Elisa Molstad3
1Department of Family Medicine, University of Alberta, Edmonton, Canada.
PloS one
|December 21, 2023
概括
许多以前被认为是他类药物不耐受症的患者,在盲目重试后可以耐受他类药物. 虽然他类药物不耐受性高于安慰剂,但肌痛和症状得分没有显著差异,这表明许多感知不耐受性可能与药物无关.
科学领域:
- 心脏病学 心脏病学
- 临床药理学 临床药理学
- 基于证据的医学基于证据的医学.
背景情况:
- 由于骨髓疼痛而停止使用他类药物是常见的,但因果关系往往未被证明.
- 在以前不耐受的患者中,在盲目的再试验时,他类药物的耐受性仍然不清楚.
研究的目的:
- 系统地审查和元分析随机对照试验 (RCT),评估成年人对他类药物不耐受的他类药物再试验与安慰剂.
- 评估药物不耐受的主要结果和肌痛的次要结果和全球症状得分.
主要方法:
- 8个RCT (PROSPERO CRD42023437648) 的系统审查和元分析,涉及8至491名参与者.
- 搜索了Medline,Embase,CINAHL Plus,Scopus和CENTRAL从开始到2023年5月的时间.
- 使用Cochrane协作工具提取数据和评估偏差风险;使用固定效应的Mantle-Haenszel统计数据估计相对风险 (RR) 和平均差异 (MD).
主要成果:
- 与安慰剂接受者相比,使用他类药物的药物不耐受性更为频繁 (36%对26%,RR 1.40,95%CI 1.23-1.60).
- 在他类药物和安慰剂组之间,在肌痛或总体症状得分上没有观察到统计学上显著的差异 (MD 1.08,95% CI -1.51-3.67).
- 只有三分之一的先前被认为是他类药物不耐受的人在盲目重试时无法耐受他类药物;四分之一的人对安慰剂不耐受.
结论:
- 药物不耐受性在先前不耐受的患者中比安慰剂更常见.
- 盲目重试表明,感知到的大部分他类药物不耐受可能不是直接由他类药物引起的.
- 需要进一步的研究来解决局限性,包括依赖于不耐受性评估的中止和交叉/非1试验中的潜在偏差.
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