活动期Graves眼病不同治疗方法的综合比较:系统综述和基于贝叶斯模型的网络meta分析。

IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Yanlin Xu, Ruikang Liu, Liying Huang, You Qin, Wei Liu, Shenyu Huang, Jiaoyue Zhang
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引用次数: 0

摘要

研究目的本研究旨在评估活动性甲状腺眼病各种治疗方法的有效性和安全性:我们对截至2024年11月20日的针对甲状腺眼病治疗的随机对照试验(RCT)和在对照试验网站上注册的进行中RCT进行了全面检索。该网络荟萃分析采用贝叶斯框架,计算风险比 (RR) 或平均差 (MD) 以及 95% 置信区间 (CI),以确定预定结果的效应大小。该研究已在 PROSPERO 注册(CRD42024548030):评估的主要结果包括总体反应率、临床活动评分(CAS)、突眼、复视和不良事件:在总体应答率方面,特普鲁单抗(RR 5.5,95%CI 2.3-16)、霉酚酸酯联合静脉糖皮质激素(IVGCs)的疗效优于无治疗,疗效由高到低排列。值得注意的是,替普鲁单抗在减少 CAS(MD -1.57,95%CI -3.81至0.68)和突眼(MD -2.29,95%CI -2.73至-1.86)方面的疗效最高。在复视改善方面,特普妥单抗和IVGCs比不治疗有效:结论:与不治疗相比,替普鲁单抗可能是减轻炎症和提高总体反应率的最有效治疗方法,而口服霉酚酸酯联合静脉注射糖皮质激素似乎是改善突眼的最佳治疗方法。尽管一些治疗方法因不良反应的报道而引起了安全性问题,但口服甲氨蝶呤联合静脉注射糖皮质激素似乎在疗效和安全性之间取得了良好的平衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comprehensive Comparisons of Different Treatments for Active Graves Orbitopathy: A Systematic Review and Bayesian Model-Based Network Meta-Analysis.

Context: Graves orbitopathy is a specialized immunoinflammatory disorder related to abnormal thyroid function. Due to the complexity of the disease and its propensity to reoccur, targeted treatment is essential to improve the symptoms.

Objective: This study aims to assess the efficacy and safety of various treatments for active thyroid eye disease.

Methods: We conducted a comprehensive search for randomized controlled trials (RCTs), and ongoing RCTs registered on Controlled Trials, targeting treatments for thyroid eye disease until November 20, 2024. Employing a Bayesian framework, this network meta-analysis calculated risk ratios (RRs) or mean differences (MDs) with 95% CIs to size the effects for the predetermined outcomes. The study is registered with PROSPERO (CRD42024548030).

Outcome: The primary outcomes evaluated were overall response rate, clinical activity score (CAS), proptosis, diplopia, and adverse events.

Results: For the overall response rate, teprotumumab (RR 5.5, 95% CI 2.3 to 16), mycophenolate combined intravenous glucocorticosteroids (IVGCs) demonstrated effectiveness over no treatment, ranked from most to least effective. Notably, teprotumumab showed the highest efficacy in reducing CAS (MD -1.57, 95% CI -3.81 to 0.68) and proptosis (MD -2.29, 95% CI -2.73 to -1.86). For diplopia improvement, teprotumumab and IVGCs were effective compared with no treatment.

Conclusion: Teprotumumab emerges as potentially the most effective treatment for reducing inflammation and increasing overall response rates when compared with no treatment; oral mycophenolate combined with IVGCs appears to be the best for improving proptosis. While some treatments raise safety concerns due to reported adverse events, oral methotrexate combined with IVGCs appear to offer a favorable balance between efficacy and safety among the evaluated treatments.

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来源期刊
Journal of Clinical Endocrinology & Metabolism
Journal of Clinical Endocrinology & Metabolism 医学-内分泌学与代谢
CiteScore
11.40
自引率
5.20%
发文量
673
审稿时长
1 months
期刊介绍: The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.
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