Systematic Review of l‐glutamine for Prevention of Vaso‐occlusive Pain Crisis in Patients with Sickle Cell Disease

Nicole E. Cieri‐Hutcherson, T. Hutcherson, Erin E. Conway‐Habes, Brianna N. Burns, Nathan A. White
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引用次数: 23

Abstract

l‐glutamine was approved by the U.S. Food and Drug Administration (FDA) for sickle cell disease (SCD) in 2017. A vaso‐occlusive crisis (VOC) occurs in persons with SCD and is associated with acute pain episodes. This systematic review summarizes the evidence for l‐glutamine in the prevention of VOC and associated pain in patients with SCD. Medline, Embase, and International Pharmaceutical Abstracts were searched for records reporting on l‐glutamine use in persons with SCD. Eligibility criteria identified primary reports of investigations conducted in humans who were administered l‐glutamine, reported on outcomes related to VOC or associated pain, published in English, and were available as full text. All relevant efficacy, safety, participant demographic data, and study method characteristics were extracted and documented. Risk‐of‐bias assessments were conducted using the Risk of Bias in Non‐Randomized Studies‐of Interventions (ROBINS‐I) tool and the revised Cochrane risk‐of‐bias tool for randomized studies. Three studies assessing the effect of exogenous l‐glutamine administration in patients with SCD met eligibility criteria: one prospective nonrandomized controlled study and two prospective randomized controlled trials. Rate of VOC and related hospitalizations were reduced in patients receiving l‐glutamine, although some conflicting results were noted between studies. l‐glutamine was generally well tolerated. Limitations of one or more of the eligible studies included small sample size, nonblinding, and study groups that differed at baseline. l‐glutamine has limited high‐quality evidence supporting its use. Although l‐glutamine is FDA approved for the prevention of frequent episodes of VOC pain, only one randomized controlled trial has strong evidence to support this indication. Based on the results of a systematic review, l‐glutamine may be considered for patients unable to receive hydroxyurea or in addition to hydroxyurea for reduction in VOC and associated pain.
l -谷氨酰胺预防镰状细胞病患者血管闭塞性疼痛危像的系统评价
l‐谷氨酰胺于2017年被美国食品和药物管理局(FDA)批准用于治疗镰状细胞病(SCD)。血管闭塞危象(VOC)发生在SCD患者中,并与急性疼痛发作有关。本系统综述总结了l -谷氨酰胺在SCD患者中预防VOC和相关疼痛的证据。我们检索了Medline、Embase和国际药物摘要中关于SCD患者使用l -谷氨酰胺的记录。资格标准确定了在给予l -谷氨酰胺的人群中进行的调查的主要报告,报告了与VOC或相关疼痛相关的结果,以英文出版,并可作为全文。提取并记录了所有相关的疗效、安全性、参与者人口统计数据和研究方法特征。使用非随机干预研究的偏倚风险(ROBINS - I)工具和修订后的Cochrane随机研究的偏倚风险工具进行偏倚风险评估。评估外源性l‐谷氨酰胺给药对SCD患者影响的三项研究符合入选标准:一项前瞻性非随机对照研究和两项前瞻性随机对照试验。在接受l -谷氨酰胺治疗的患者中,挥发性有机化合物的发生率和相关的住院率降低,尽管在研究中注意到一些相互矛盾的结果。L‐谷氨酰胺一般耐受良好。一个或多个符合条件的研究的局限性包括样本量小、非盲性和研究组在基线时不同。谷氨酰胺支持其使用的高质量证据有限。虽然l -谷氨酰胺被FDA批准用于预防VOC疼痛的频繁发作,但只有一项随机对照试验有强有力的证据支持这一适应症。基于系统评价的结果,l -谷氨酰胺可以被考虑用于不能接受羟脲治疗的患者,或者除了羟脲治疗外,还可以用于减少VOC和相关疼痛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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