机构地区:[1]四川大学华西医院临床药学部,四川成都610041 [2]四川大学华西药学院,四川成都610041
出 处:《中国药业》2022年第1期110-116,共7页China Pharmaceuticals
基 金:四川省卫生和计划生育委员会科研课题[18PJ533]。
摘 要:目的评价白细胞介素1(IL-1)受体拮抗剂治疗痛风急性发作的有效性与安全性。方法通过计算机检索Medline和Embase,以及中国知网、万方、维普数据库中IL-1受体拮抗剂治疗痛风的随机对照试验(RCT),检索时限均为自建库起至2020年9月。由2位评价员独立筛选文献、提取信息,采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具评价纳入研究的偏倚风险,采用RevMan 5.4软件进行Meta分析。结果共纳入10项RCT,试验组药物包括阿那白滞素、利纳西普、卡那单抗。Meta分析结果显示,试验组(10,25,50,90,150 mg卡那单抗)C反应蛋白水平与对照组相比,各亚组间差异均无统计学意义(P>0.05);试验组(160 mg利纳西普)痛风发作次数显著低于安慰剂组(P<0.05);利纳西普联合吲哚美辛组的Likert五分量表和11点数字评分法评分与吲哚美辛单药治疗组比较,差异无统计学意义(P>0.05),试验组和对照组所有不良反应发生率比较,差异有统计学意义[OR=1.22,95%CI(1.02,1.47),P=0.03];试验组和对照组头痛发生率比较,差异无统计学意义[OR=1.31,95%CI(0.87,1.98),P=0.20];试验组和对照组鼻咽炎发生率比较,差异无统计学意义[OR=2.50,95%CI(0.96,6.55),P=0.06];试验组和对照组上呼吸道感染发生率比较,差异无统计学意义[OR=1.22,95%CI(0.70,2.12),P=0.48];试验组和对照组注射部位反应发生率比较,差异有统计学意义[OR=7.69,95%CI(3.23,18.31),P<0.00001];试验组和对照组总感染发生率比较,差异无统计学意义[OR=1.04,95%CI(0.61,1.76),P=0.90];试验组腿部鳞状细胞癌和前列腺癌发生率分别为0.62%(1/161)和2.44(1/41),对照组上述不良事件发生率均为0,但认为其与治疗无关。结论IL-1受体拮抗剂治疗痛风急性发作疗效较好,但受其不良反应及成本限制,不推荐作为痛风的一线治疗药物。Objective To evaluate the efficacy and safety of interleukin-1(IL-1)receptor antagonist in the treatment of acute gout attack.Methods Databases including Medline,Embase,CNKI,WanFang,VIP were searched electronically to collect the randomized controlled trials(RCTs)of IL-1 receptor antagonists in the treatment of gout from inception to September 2020.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies by using the Cochrane Handbook(Version 5.1).The Meta-analysis was performed by using the RevMan 5.4 software.Results Ten RCTs were included.The drugs in the experimental group included anakinra,rilonacept and canakinumab.Meta-analysis results show that there was no significant difference in the level of C-reactive protein(CRP)in the experimental subgroups(10,25,50,90,150 mg of canakinumab)and the control group(P>0.05),the times of gout attacks in the experimental groups(160 mg of rilonacept)were significantly fewer than that in the placebo group(P<0.05).There was no significant difference in the scores of the Likert scale and 11-point digital scoring method between the rilonacept combined with the indometacin group and the indometacin monotherapy group(P>0.05).The incidence of all adverse reactions in the experimental group was significantly different from that in the control group[OR=1.22,95%CI(1.02,1.47),P=0.03].There was no significant difference in the incidence of headache between the experimental group and the control group[OR=1.31,95%CI(0.87,1.98),P=0.20].There was no significant difference in the incidence of nasopharyngitis[OR=2.50,95%CI(0.96,6.55),P=0.06]or the incidence of upper respiratory tract infection[OR=1.22,95%CI(0.70,2.12),P=0.48]between the experimental group and the control group.The incidence of injection site reactions in the experimental group was significantly different from that in the control group[OR=7.69,95%CI(3.23,18.31),P<0.00001].There was no significant difference in the total incidence of infection between the experimental g
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...