载脂蛋白C-III抑制剂治疗高甘油三酯血症：随机对照试验的荟萃分析

IF 10.8 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Metabolism: clinical and experimental Pub Date : 2025-03-10 DOI:10.1016/j.metabol.2025.156187

Mariana de Moura de Souza , Beatriz Ximenes Mendes , Maria Luiza Rodrigues Defante , Beatriz Austregélio de Athayde de Hollanda Morais , Otávio Cosendey Martins , Vitória Martins Prizão , Gabriela Romaniello

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引用次数: 0

摘要

导论：高甘油三酯血症与动脉粥样硬化性心血管风险和胰腺炎风险相关。载脂蛋白C-III （APOC-III）抑制剂的有效性和安全性尚不清楚。目的：探讨APOC-III抑制剂对高甘油三酯血症及其并发症的影响。方法：我们系统地检索PubMed， Embase和Cochrane Central数据库，从建立到2024年5月，比较APOC-III抑制剂和安慰剂对高甘油三酯血症患者的随机对照试验（rct）。我们分别汇总了连续和二元结果的标准化平均差（SMD）变化百分比和风险比（RR），置信区间（CI）为95% %。对APOC-III抑制剂药物剂量（Olezarsen、Volanesorsen和plzasiran）以及原发性和继发性高甘油三酯血症进行亚组分析。结果：纳入10项随机对照试验，1204名受试者，其中46% %为男性。APOC-III抑制剂显著降低甘油三酯（TG） (SMD: -60.56 %；95 % CI -68.94 ~ -52.18；p 结论：APOC-III抑制剂改善TG水平和其他脂质面板参数，并减少原发性和继发性高甘油三酯血症患者的急性胰腺炎发作。

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Apolipoprotein C-III inhibitors for the treatment of hypertriglyceridemia: a meta-analysis of randomized controlled trials

Introduction

Hypertriglyceridemia is related to atherosclerotic cardiovascular risk and pancreatitis risk. The efficacy and safety of apolipoprotein C-III (APOC-III) inhibitors remains unclear.

Aim

To investigate the effects of APOC-III inhibitors on hypertriglyceridemia and its complications.

Methods

We systematically searched PubMed, Embase, and Cochrane Central databases from inception to May 2024 for randomized controlled trials (RCTs) comparing APOC-III inhibitors to placebo in patients with hypertriglyceridemia. We pooled percentage standardized mean difference (SMD) changes and risk ratio (RR) for continuous and binary outcomes, respectively, with 95 % confidence interval (CI). Subgroup analyses were performed with APOC-III inhibitors drugs doses (Olezarsen, Volanesorsen and Plozasiran), and primary and secondary hypertriglyceridemia.

Results

10 RCTs with 1204 participants were included, of which 46 % were men. APOC-III inhibitors significantly reduced triglycerides (TG) (SMD: −60.56 %; 95 % CI −68.94 to −52.18; p < 0.00001), APOC-III (SMD: −75.44 %; 95 % CI −80.81 to −70.07; p < 0.00001) and non-HDL-c (SMD: −27.49 %; 95 % CI −34.16 to −20.82; p < 0.00001) levels. Consistent results were found for all subgroup analyses. APOC-III inhibitors were capable to normalize TG levels in patients with severe hypertriglyceridemia (RR: 7.92; 95 % CI 4.12 to 15.23; p < 0.00001). There was a significant increase in HDL-c (SMD: 43.92 %; 95 % CI 37.27 to 50.57; p < 0.00001) and LDL-c (SMD: 33.05 %; 95 % CI 9.08 to 57.01; p = 0.007) levels. There was a significant relative risk reduction in acute pancreatitis in the APOC-III inhibitors group (RR 0.17; 95 % CI 0.05 to 0.53; p = 0.007). Adverse events were similar in both groups.

Conclusion

APOC-III inhibitors improve TG levels and other lipid panel parameters, as well as reduce episodes of acute pancreatitis in patients with primary and secondary hypertriglyceridemia.

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来源期刊

Metabolism: clinical and experimental 医学-内分泌学与代谢

CiteScore

18.90

自引率

3.10%

发文量

310

审稿时长

16 days

期刊介绍： Metabolism upholds research excellence by disseminating high-quality original research, reviews, editorials, and commentaries covering all facets of human metabolism. Consideration for publication in Metabolism extends to studies in humans, animal, and cellular models, with a particular emphasis on work demonstrating strong translational potential. The journal addresses a range of topics, including: - Energy Expenditure and Obesity - Metabolic Syndrome, Prediabetes, and Diabetes - Nutrition, Exercise, and the Environment - Genetics and Genomics, Proteomics, and Metabolomics - Carbohydrate, Lipid, and Protein Metabolism - Endocrinology and Hypertension - Mineral and Bone Metabolism - Cardiovascular Diseases and Malignancies - Inflammation in metabolism and immunometabolism