针对渐进性多发性硬化症的免疫调节剂和免疫抑制剂:一个网络元分析
Ben Ridley1, Silvia Minozzi2, Marien Gonzalez-Lorenzo3
1IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
The Cochrane database of systematic reviews
|September 10, 2024
概括
这项网络元分析发现,治疗方法减少渐进性多发性硬化症 (PMS) 复发的证据有限. 一些药物显示复发的轻微减少,但由于不良事件的更高的停用率被注意到几个治疗.
科学领域:
- 神经学和免疫学 神经学和免疫学
- 临床试验分析
- 药理学研究 药理学研究
背景情况:
- 新兴的免疫调节和免疫抑制治疗渐进性多发性硬化症 (PMS) 提供了新的选择.
- 缺乏直接比较试验,阻碍了对PMS治疗的相对益处和安全性概况的理解.
研究的目的:
- 进行一个网络元分析,比较许多治疗渐进性多发性硬化症 (PMS) 的疗效和安全性.
- 评估包括阿勒姆图祖马布,芬戈利莫德,纳塔利祖马布,奥克雷利祖马布,瑞图西马布和干扰素β在内的PMS治疗方法.
主要方法:
- 在2022年8月之前对CENTRAL,MEDLINE,Embase,ClinicalTrials.gov和WHO ICTRP进行系统搜索.
- 包括23个随机对照试验 (RCT) 与10,167名参与者,将单疗法与安慰剂或活性剂进行比较.
- 使用对智和网络元分析进行数据综合,用GRADE评估证据确定性.
主要成果:
- 与安慰剂相比,中度确定性证据表明,利图西马布可能会在24个月内略有减少复发,而干扰素β-1b在36个月内略有减少复发.
- 高确定性证据表明干扰素β-1a因不良事件而导致停药增加;中等确定性表明rituximab,干扰素β-1b,免疫球蛋白,glatiramer乙酸盐,fingolimod和ocrelizumab的类似增加.
- 对残疾进展和严重不良事件的证据确定性低至非常低,通常是由于不精确和短时间的随访.
结论:
- 利图西马布和干扰素β-1b可以在渐进的多发性硬化症 (PMS) 中略微减少复发,但随着不良事件中止率的增加.
- 对残疾进展和严重不良事件的证据的有限确定性需要进一步的研究.
- 未来的研究应该优先考虑对比试验,长时间的随访期和对患者有意义的一致结果措施.
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