Francisca Johanna van den Oever, Marijke J E Dekker, Erwin C Vasbinder, Teun van Gelder, Patricia M L A Van den Bemt
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引用次数: 0
Abstract
Objectives: The goal of this systematic review was to identify and summarise algorithm-managed and pharmacist-managed dosing of erythropoietin stimulating agents (ESA) in patients with renal anaemia and to determine the effects on available outcome parameters.
Methods: We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for systematic reviews. Studies investigating algorithm-managed and pharmacist-managed dosing of ESA in adult patients with renal anaemia were evaluated for inclusion. No restrictions were set on outcome parameters. Observational and interventional studies available as full-text articles with a control group and follow-up ≥6 months were eligible for inclusion. Relevant databases were searched from their inception through August 2024. Two independent reviewers evaluated all studies. The risk of bias was assessed by the ROBINS-I and RoB1 tools. The protocol of this study was registered in PROSPERO (CRD42021243678).
Results: After screening 140 articles, 17 articles and 4313 patients could be included. Available evidence was of low to moderate quality with a high risk of bias. Data were summarised and tabulated. Meta-analysis was not possible due to the substantial heterogeneity in participants, study design, interventions, comparisons, and outcome parameters. However, standardised metrics could be identified and calculated for haemoglobin and ESA dose. The percentage in target range for haemoglobin varied between 3.5% lower (95% CI -18.67% to +11.67%) to 32.0% higher (95% CI 14.07% to 49.93%) in the pharmacist-managed group versus the control group (n=1401). The range in reduction in ESA dose was 5.45% (95% CI -7.97% to +18.87%) to 49.97% (95% CI 20.32% to 79.61%) in the pharmacist-managed group versus the control group (n=2115).
Conclusion: Low-quality data with high risk of bias suggest that pharmacist-managed renal anaemia may improve the percentage of haemoglobin within target range and reduce the ESA dose. However, meta-analysis was impossible due to substantial heterogeneity. Therefore, no definite conclusions could be drawn on the effectiveness of pharmacist-managed dosing of ESA in renal anaemia.
目的：本系统综述的目的是确定和总结算法管理和药剂师管理的促红细胞生成素刺激剂（ESA）在肾性贫血患者中的剂量，并确定对可用结局参数的影响。方法：我们遵循PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。对算法管理和药剂师管理的ESA给药成人肾性贫血患者的研究进行纳入评估。没有对结果参数设置限制。观察性和干预性研究，包括对照组和随访≥6个月的全文文章，符合纳入条件。从成立到2024年8月，对相关数据库进行了检索。两名独立审稿人评估了所有研究。通过ROBINS-I和RoB1工具评估偏倚风险。本研究的方案已在PROSPERO注册（CRD42021243678）。结果：筛选140篇文献，最终纳入17篇文献，4313例患者。现有证据为低到中等质量，偏倚风险高。对数据进行汇总和制表。由于参与者、研究设计、干预措施、比较和结果参数存在大量异质性，因此无法进行meta分析。然而，可以确定和计算血红蛋白和欧空局剂量的标准化指标。与对照组（n=1401）相比，药剂师管理组血红蛋白目标范围内的百分比在3.5% （95% CI -18.67%至+11.67%）至32.0% （95% CI 14.07%至49.93%）之间变化。与对照组（n=2115）相比，药剂师管理组的ESA剂量减少幅度为5.45% （95% CI -7.97%至+18.87%）至49.97% （95% CI 20.32%至79.61%）。结论：低质量、高偏倚风险的数据表明，药师管理的肾性贫血可能提高血红蛋白在目标范围内的百分比，并减少ESA剂量。然而，由于存在大量异质性，无法进行meta分析。因此，没有明确的结论可以得出药剂师管理剂量的ESA在肾性贫血的有效性。普洛斯彼罗注册号：CRD42021243678。
期刊介绍：
European Journal of Hospital Pharmacy (EJHP) offers a high quality, peer-reviewed platform for the publication of practical and innovative research which aims to strengthen the profile and professional status of hospital pharmacists. EJHP is committed to being the leading journal on all aspects of hospital pharmacy, thereby advancing the science, practice and profession of hospital pharmacy. The journal aims to become a major source for education and inspiration to improve practice and the standard of patient care in hospitals and related institutions worldwide.
EJHP is the only official journal of the European Association of Hospital Pharmacists.
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