大剂量甲氨蝶呤尿液碱化的口服方案:系统回顾和荟萃分析。

IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY
DARU Journal of Pharmaceutical Sciences Pub Date : 2024-06-01 Epub Date: 2024-01-17 DOI:10.1007/s40199-023-00499-3
Romina Kaveh-Ahangaran, Mohammad Abdollahi, Mohammad Vaezi, Amir Kasaeian, Zhalleh Bahlouli, Ghasem Janbabaei, Amirmahdi Mojtahedzadeh, Mojtaba Mojtahedzadeh, Shirin Djalalinia, Bita Shahrami
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引用次数: 0

摘要

目的:尿液碱化可防止接受大剂量甲氨蝶呤(HDMTX)治疗的患者出现肾毒性。虽然标准方法是静脉注射碳酸氢钠,但在药物短缺和门诊环境中,替代性口服碳酸氢盐方案也至关重要。本研究旨在回顾这些方案的有效性和安全性:方法:采用 PRISMA 协议系统地检索了 PubMed、WOS 和 Scopus 上涉及人体的相关研究,包括随机临床试验、回顾性研究、前瞻性研究、队列研究、病例报告和病例系列研究。对语言、时间或年龄组没有限制。合格且符合条件的论文用于提取疗效和安全性指标的数据,并使用非随机干预研究中的偏倚风险(ROBINS-I)评估工具对最终相关记录进行质量评估:12项研究共1212名参与者被纳入系统综述,其中8项研究的汇总数据被用于荟萃分析。除尿液 pH 值降至结论值外,口服碳酸氢盐疗法后的平均差(MDs)或几率比(OR)均无明显差异:口服碳酸氢盐方案是碱化 HDMTX 尿液的一种安全有效的方法,是静脉注射方案的一种可行且经济有效的替代方案。有必要进一步开展前瞻性多中心研究。系统综述注册标识符:CRD42023379666。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Oral regimen for high dose methotrexate urine alkalinization: a systematic review and meta-analysis.

Oral regimen for high dose methotrexate urine alkalinization: a systematic review and meta-analysis.

Objective: Urine alkalinization prevents nephrotoxicity in patients receiving high-dose methotrexate (HDMTX). While the standard approach involves IV sodium bicarbonate, alternative oral bicarbonate regimens are crucial in drug shortages and outpatient settings. This study aims to review the efficacy and safety of such regimens.

Methods: PubMed, WOS, and Scopus were systematically searched using the PRISMA protocol for relevant studies involving human subjects, including randomized clinical trials, retrospective, prospective, cohort, case reports, and case series studies. There were no restrictions on language, time, or age group. Qualified and eligible papers were used to extract data on efficacy and safety indicators, and the final relevant records were assessed for quality using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) assessment tool.

Results: 12 studies with 1212 participants were included in the systematic review, with pooled data from 8 studies used for meta-analysis. No significant differences in mean differences (MDs) or odds ratio (OR) were found after the oral bicarbonate regimen, except for when urine pH fell to < 7 (MD: 0.91, 95% CI: 0.32, 1.5, P < 0.05) and the incidence of diarrhea (OR: 2.92, 95% CI: 1.69, 5.05, P < 0.05).

Conclusion: An oral bicarbonate regimen is a safe and effective way to alkalize HDMTX urine, providing a viable and cost-effective alternative to IV protocols. Further prospective multicenter studies are necessary. Systematic review registration identifier: CRD42023379666.

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来源期刊
DARU Journal of Pharmaceutical Sciences
DARU Journal of Pharmaceutical Sciences PHARMACOLOGY & PHARMACY-
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期刊介绍: DARU Journal of Pharmaceutical Sciences is a peer-reviewed journal published on behalf of Tehran University of Medical Sciences. The journal encompasses all fields of the pharmaceutical sciences and presents timely research on all areas of drug conception, design, manufacture, classification and assessment. The term DARU is derived from the Persian name meaning drug or medicine. This journal is a unique platform to improve the knowledge of researchers and scientists by publishing novel articles including basic and clinical investigations from members of the global scientific community in the forms of original articles, systematic or narrative reviews, meta-analyses, letters, and short communications.
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