抗组胺药治疗难治性慢性自发性荨麻疹的疗效和安全性:系统综述和网络荟萃分析

Benjamin Kendziora M.D. Ph.D., Jessica Frey,  Markus Reinholz M.D. Ph.D.,  Franziska Ruëff M.D., Eva Oppel M.D.,  Torsten Zuberbier M.D.,  Daniela Hartmann M.D. Ph.D., Justin G. Schlager M.D.,  Lars E. French M.D.
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引用次数: 0

摘要

摘要目的大多数治疗抗组胺药难治性慢性自发性荨麻疹(CSU)的药物尚未进行正面比较。这项系统综述和网络荟萃分析评估了它们的相对疗效和安全性。方法检索电子数据库,直到2022年5月5日,以进行随机对照试验,研究抗组胺难治性CSU的全身药物治疗。使用随机效应网络荟萃分析模型比较两种治疗之间7天内荨麻疹活动评分(UAS7)的变化和不良事件的发生。结果共纳入32项研究,3641名患者接受了31种不同的系统性医疗干预。在目前可用的药物中,奥马珠单抗300 每4周注射mg,环孢菌素3-5 与安慰剂相比,每天口服mg/kg最有效地降低了UAS7,降低了−10.45(95%置信区间[CI]:−12.35,−8.55)和−10.40(95%可信区间:−19.4,−1.4)。未经批准的药物利格列珠单抗72也显示出类似的疗效 mg每4周注射一次(−11.67,95%置信区间:−16.80,−7.15)和非尼布替尼400 mg每日口服(−9.50,95%可信区间:−17.56,−1.44)。以安慰剂为对照,在上述剂量下,奥马珠单抗发生不良事件的比值比为1.09(95%可信区间为0.83,1.42),环孢菌素发生不良事件为2.16(95%可信范围为0.77,6.07:GRADE;中度确定性),利格列珠单抗发生不利事件的比值比为0.89(95%置信区间为0.47,1.69),非尼布替尼发生不良事件(95%可信系数为0.62,7.38)。结论奥马珠单抗300 每4周注射mg,环孢菌素3-5 每日口服mg/kg是目前治疗抗组胺难治性CSU最有效的药物。环孢菌素的安全性相对较差。
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Efficacy and safety of medications for antihistamine-refractory chronic spontaneous urticaria: a systematic review and network meta-analysis

Summary

Purpose

Most medications for antihistamine-refractory chronic spontaneous urticaria (CSU) have not been compared head-to-head. This systematic review and network meta-analysis evaluates their relative efficacy and safety.

Methods

Electronic databases were searched until 05 May 2022 for randomized controlled trials investigating systemic medications for antihistamine-refractory CSU. The change in the urticaria activity score over seven days (UAS7) and occurrence of adverse events were compared between treatments using random-effects network meta-analysis models.

Results

In all, 32 studies with 3641 patients receiving 31 different systemic medical interventions were included. Among currently available drugs, omalizumab 300 mg injected every 4 weeks and cyclosporine 3–5 mg/kg daily per os were most effective in reducing the UAS7 with a reduction of −10.45 (95% confidence interval [CI]: −12.35, −8.55) and of −10.40 (95% CI: −19.4, −1.4) compared to placebo. Similar efficacies were shown by the nonapproved agents ligelizumab 72 mg injected every 4 weeks (−11.67, 95% CI: −16.80, −7.15) and fenebrutinib 400 mg daily per os (−9.50, 95% CI: −17.56, −1.44). The odds ratio for the occurrence of an adverse event with placebo as comparator was 1.09 for omalizumab (95% CI: 0.83, 1.42), 2.16 for cyclosporine (95% CI: 0.77, 6.07: GRADE; moderate certainty), 0.89 for ligelizumab (95% CI: 0.47, 1.69), and 2.14 for fenebrutinib (95% CI: 0.62, 7.38) in the mentioned dosages.

Conclusion

Omalizumab 300 mg injected every 4 weeks and cyclosporine 3–5 mg/kg daily per os are the most effective currently available drugs for antihistamine-refractory CSU. Cyclosporine shows a relatively less favorable safety profile.

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来源期刊
Allergo Journal International
Allergo Journal International Medicine-Immunology and Allergy
CiteScore
4.60
自引率
0.00%
发文量
31
期刊介绍: Allergo Journal International is the official Journal of the German Society for Applied Allergology (AeDA) and the Austrian Society for Allergology and Immunology (ÖGAI). The journal is a forum for the communication and exchange of ideas concerning the various aspects of allergy (including related fields such as clinical immunology and environmental medicine) and promotes German allergy research in an international context. The aim of Allergo Journal International is to provide state of the art information for all medical and scientific disciplines that deal with allergic, immunological and environmental diseases. Allergo Journal International publishes original articles, reviews, short communications, case reports, and letters to the editor. The articles cover topics such as allergic, immunological and environmental diseases, the latest developments in diagnosis and therapy as well as current research work concerning antigens and allergens and aspects related to occupational and environmental medicine. In addition, it publishes clinical guidelines and position papers approved by expert panels of the German, Austrian and Swiss Allergy Societies. All submissions are reviewed in single-blind fashion by at least two reviewers. Originally, the journal started as a German journal called Allergo Journal back in 1992. Throughout the years, English articles amounted to a considerable portion in Allergo Journal. This was one of the reasons to extract the scientific content and publish it in a separate journal. Hence, Allergo Journal International was born and now is the international continuation of the original German journal. Nowadays, all original content is published in Allergo Journal International first. Later, selected manuscripts will be translated and published in German and included in Allergo Journal.
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