The effect of different levothyroxine administration regimens on thyroid hormone levels: a systematic review, pairwise, and network meta-analysis.

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Expert Review of Clinical Pharmacology Pub Date : 2024-03-01 Epub Date: 2024-02-05 DOI:10.1080/17512433.2024.2313616

Bianca Vendruscolo Bianchini, Patricia Romualdo de Jesus, Renato Gorga Bandeira de Mello, Patricia Klarmann Ziegelmann, Kristian Bellevue Filion, Tatiane da Silva Dal Pizzol

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引用次数: 0

Abstract

Introduction: This systematic review aimed to compare the effect of alternative levothyroxine administration regimens on thyroid hormone levels and patient-reported outcomes (PROs) among adults with hypothyroidism.

Methods: We searched PubMed, Embase, CENTRAL, CINAHL, LILACS, SciELO, Scopus, Web of Science, OpenGrey, ProQuest, ClinicalTrials.gov, and ICTRP from inception to May/2023 for randomized controlled trials (RCTs). We assessed the risk of bias with Cochrane Risk of Bias 2.0 tool. We analyzed TSH levels by pairwise and network meta-analyses (NMA). The FT4 levels and PROs were qualitatively assessed.

Results: We included 14 RCTs (906 participants) comparing different regimens, as bedtime vs. before breakfast. A total of 12 RCTs were at high risk of bias. Seven RCTs were included in the TSH meta-analysis, where the mean difference (MD) and 95% confidence interval (CI) were as follows: bedtime vs before breakfast (4 RCTs) 0.69 (-1.67-3.04), I² = 92%, very low certainty evidence; weekly dose vs before breakfast (2 RCTs) 1.68 (0.94-2.41), I² = 0%, low certainty evidence; and at breakfast vs before breakfast (1 RCT) 0.65 (-1.11-2.41), very low certainty evidence. The NMA showed no evidence of differences in TSH level with different regimens.

Conclusion: The evidence is insufficient to determine the most effective levothyroxine administration regimen for hypothyroidism.

Systematic review registration: PROSPERO - CRD42021279375.

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甲状腺功能减退症中的左甲状腺素给药方案不同左甲状腺素给药方案对甲状腺激素水平的影响：系统综述、配对分析和网络荟萃分析。

简介：这是一项系统性综述：本系统性综述旨在比较左甲状腺素替代给药方案对甲状腺激素水平和甲状腺功能减退症成人患者报告结果（PROs）的影响：我们检索了 PubMed、Embase、CENTRAL、CINAHL、LILACS、SciELO、Scopus、Web of Science、OpenGrey、ProQuest、ClinicalTrials.gov 和 ICTRP 从开始到 2023 年 5 月的随机对照试验 (RCT)。我们使用 Cochrane Risk of Bias 2.0 工具评估了偏倚风险。我们通过配对分析和网络荟萃分析（NMA）对 TSH 水平进行了分析。对FT4水平和PROs进行了定性评估：我们纳入了 14 项 RCT（906 名参与者），对不同的治疗方案（睡前与早餐前）进行了比较。共有 12 项研究存在高偏倚风险。在 TSH 的荟萃分析中纳入了 7 项研究，其平均差（MD）和 95% 置信区间（CI）为：睡前与早餐前（4 项研究）0.69（-1.67 - 3.0.69（-1.67 - 3.04），I2 = 92%，确定性证据极低；每周用药 vs 早餐前用药（2 项 RCT）1.68（0.94 - 2.41），I2 = 0%，确定性证据低；早餐时用药 vs 早餐前用药（1 项 RCT）0.65（-1.11 - 2.41），确定性证据极低。NMA显示，没有证据表明不同治疗方案的TSH水平存在差异：证据不足以确定治疗甲减最有效的左旋甲状腺素给药方案：系统综述注册：PROCROPERO - CRD42021279375。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.