Efficacy and Safety of Biologics and Immunosuppressants in Maintenance Therapy for Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Network Meta-Analysis.
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Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a potentially life-threatening systemic autoimmune disease. This study aims to compare the effectiveness and safety of biologics and immunosuppressive agents in the maintenance treatment of AAV. A comprehensive search was conducted in Medline, PubMed, Embase, and the Cochrane Library databases to identify the relevant randomised controlled trials (RCTs). Nine RCTs involving 1,157 patients were included. For primary efficacy, rituximab had a lower relapse rate than azathioprine (AZA) and mycophenolate mofetil (MMF) (odds ratio (OR): 0.47, 95% confidence interval (CI): 0.26-0.84 and OR: 0.23, 95% CI: 0.08-0.68, respectively). Based on the result of the surface under the cumulative ranking curve (SUCRA), rituximab had the highest probability of reducing relapse (SUCRA = 86.6%), followed by cyclophosphamide (CYC), belimumab + AZA, methotrexate (MTX), AZA, and MMF. Regarding major relapse, rituximab also showed the highest probability (SUCRA = 93.6%). Concerning safety, there were no significant differences in the incidence of SAEs and serious infection among the different medicines. According to the SUCRA, MMF had the lowest probability of SAEs and serious infection. In conclusion, rituximab may be a treatment method for effectively reducing relapses in AAV patients during maintenance therapy among the medicines investigated. MMF has shown the lowest incidence of SAEs and serious infection. Key Words: Immunosuppressant, Rituximab, Meta-analysis.
期刊介绍：
Journal of College of Physicians and Surgeons Pakistan (JCPSP), is the prestigious, peer reviewed monthly biomedical journal of the country published regularly since 1991.
Established with the primary aim of promotion and dissemination of medical research and contributed by scholars of biomedical sciences from Pakistan and abroad, it carries original research papers, , case reports, review articles, articles on medical education, commentaries, short communication, new technology, editorials and letters to the editor. It covers the core biomedical health science subjects, basic medical sciences and emerging community problems, prepared in accordance with the “Uniform requirements for submission to bio-medical journals” laid down by International Committee of Medical Journals Editors (ICMJE). All publications of JCPSP are peer reviewed by subject specialists from Pakistan and locally and abroad.
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