摘要
背景儿童抗髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)临床表型多样,根据病程可分为单相性和多相性,约50%的患儿表现为多相性病程。多相性MOGAD反复发作会遗留不同程度的神经系统功能损害。预防多相性MOGAD复发的药物主要包括吗替麦考酚酯、利妥昔单抗、硫唑嘌呤以及每月维持静脉注射IVIG,但目前预防复发的治疗方案缺乏高质量的临床研究证据。目的通过系统评价/Meta分析探讨利妥昔单抗(RTX)治疗MOGAD的有效性。设计系统评价/Meta分析。方法检索中英文数据库(PubMed、Embase、Web of Science、Cochrane、万方数据库、中国知网数据库、维普数据库),筛选有关RTX治疗MOGAD的文献,检索时间为1997年1月1日至2021年6月1日。由2名研究者独立筛选文献,提取相关数据以及对纳入文献行风险偏倚评价,采用RevMan 5.3进行Meta分析。主要结局指标年复发率(ARR)、无复发率。结果共纳入13篇研究272例患者。Meta分析结果显示,RTX治疗MOGAD的无复发率为32.4%(95%CI:2.9%~47.9%,I;=52%,P=0.03),应用RTX治疗MOGAD后ARR平均变化为-1.44(95%CI:-1.67~-1.21,I;=71%,P=0.004)。结论RTX虽然可降低MOGAD患者的复发频率,但无复发率仅为32.4%,此结论有待更多高质量的研究加以验证。
Background Pediatric anti-myelin oligodendrocyte glycoprotein antibody associated disease(MOGAD)has a variety of clinical manifestations,which can be divided into monophasic and polyphasic courses according to the course of disease,of which about 50%children present with a polyphasic course.Recurrent episodes of polyphasic MOGAD lead to varying degrees of neurological impairment.The main prophylactic drugs for relapse of multiphasic MOGAD include mecophenolate mofetil(MMF),rituximab(RTX),azathioprine(AZA)and intravenous gamma globulin(IVIG)on a monthly basis.However,there is a lack of high-quality clinical evidence for the prophylactic treatment.Objective To investigate the effectiveness of rituximab in the treatment of MOGAD through a systematic review and meta-analysis.Design Systematic review/meta-analysis.Methods Literature on rituximab in the treatment of MOGAD was searched in the databases of Pubmed,Embase,Web of Science,Cochrane,Wanfang Data,CKNI and VIP from Jan 1 st,1997 to June 1 st,2021.After two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies,the meta-analysis was performed using RevMan 5.3.Main outcome measures Annualized relapse rate and relapse-free rate.Results Thirteen studies(272 patients)were included.Meta-analysis showed that the relapse-free rate of patients of MOGAD who received rituximab treatment was 32.4%(95%CI:2.9%-47.9%,I;=52%,P=0.03),and the annualized relapse rate changes-1.44(95%CI:-1.67--1.21,I;=71%,P=0.004).Conclusion Rituximab reduced the frequency of relapse in some MOGAD patients,but the relapse-free rate was only32.4%.The results of this study need to be verified by more high-quality studies.
作者
李尚茹
常旭婷
武鹏霞
张捷
吴晔
LI Shangru;CHANG Xuting;WU Pengxia;ZHANG Jie;WU Ye(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2022年第1期39-43,共5页
Chinese Journal of Evidence Based Pediatrics
