药物治疗肌萎缩性脊髓侧索硬化症有效性和安全性的网状Meta分析  

Efficacy and Safety of Pharmacological Interventions for Amyotrophic Lateral Sclerosis:A Network Meta-Analysis

作　　者：刘自强 缪锦峰 朱舟 LIU Zi-qiang;MIU Jing-feng;ZHU Zhou(Taikang Tongji(Wuhan)Hospital,Wuhan 430000,China;Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]泰康同济(武汉)医院综合医疗科 [2]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《神经损伤与功能重建》2022年第6期320-323,340,共5页Neural Injury and Functional Reconstruction

基　　金：十三五国家重点研发项目(No.2017YFC1310000);华中科技大学自主创新研究基金(No.2018KF YXMPTO15)。

摘　　要：目的:运用网状Meta分析比较利鲁唑、依达拉奉、马赛替尼、Tirasemtiv和Arimoclomol 5种药物治疗肌萎缩性脊髓侧索硬化症(ALS)的有效性和安全性。方法:检索建库至2020年7月30日的国内外数据库中与5种药物相关的随机对照试验,依据纳入排除标准对文献进行筛选,提取相关资料并使用R软件进行网状Meta分析。结果:共纳入合格文献14篇,共2767例患者。网状Meta分析结果显示,与安慰剂相比,利鲁唑能减少死亡或特定疾病状态的发生(OR=0.75,95%CI:0.58-0.96);Tirasemtiv能明显增加一般副作用的发生(OR=3.1,95%CI:2-4.8),Arimoclomol能引起更多严重副作用的发生(OR=8,95%CI:2.2-36)。相对治疗排序结果和聚类分析结果显示利鲁唑和依达拉奉在有效性和安全性排名均靠前。结论:利鲁唑和依达拉奉在治疗ALS患者时兼顾了有效性和安全性,而Arimoclomol在ALS患者身上的应用还需更多的临床实验证实其安全性。Objective:To evaluate the efficacy and safety of Riluzole,Edaravone,Mosaitini,Tirasemtiv and Arimoclomol for amyotrophic lateral sclerosis(ALS) using network meta-analysis.Methods:Domestic and foreign literature databases were searched from their establishment to July 30,2020 for randomized controlled trials that involve the above 5 medications for ALS.The literature was screened according to established criteria.Data were extracted,and network meta-analysis was performed with R software.Results:Fourteen studies involving 2767 patients were included in the analysis.Compared with the placebo,Riluzole reduced the incidence of death or disease progression in specific states(OR=0.75,95% CI:0.58-0.96),Tirasemtiv caused more general adverse events(OR=3.1,95%CI:24.8),and Arimoclomol caused more serious adverse events(OR=8,95%CI:2.2-36).Relative treatment ranking and cluster analysis showed that Riluzole and Edaravone ranked first in efficacy and safety.Conclusion:Riluzole and Edaravone are effective and safe in the treatment of ALS.More clinical trials are needed to confirm the safety of Arimoclomol in ALS patients.

关 键 词：肌萎缩侧索硬化 网状Meta分析 利鲁唑 依达拉奉 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学] R741.05R746