摘要
目的:系统评价不同方案利妥昔单抗治疗膜性肾病的有效性与安全性。方法:计算机检索PubMed、Embase、The Cochrane Library、Web of Science、Wanfang、CBM、CNKI数据库,检索时限为各数据库自建库起至2022年1月12日。筛选利妥昔单抗治疗膜性肾病的临床试验,利用Stata16.0进行网状Meta分析。结果:共纳入12项研究,网状Meta分析显示,在完全缓解率方面,最优为利妥昔单抗每次1 g,2周1次×2方案,其次为超低剂量利妥昔单抗联合方案、每周1次375 mg·m^(-2)×2联合方案、非免疫抑制剂治疗方案、他克莫司方案;部分缓解率方面,最优为他克莫司方案,其次为超低剂量利妥昔单抗联合方案、每周1次375 mg·m^(-2)×2联合方案、每周1次375 mg·m^(-2)×6联合方案、利妥昔单抗1 g×1联合方案;安全性方面,糖皮质激素方案优于B细胞滴定治疗方案、每周1次375 mg·m^(-2)×4联合方案、雷公藤多苷方案、非免疫抑制剂治疗方案。结论:尚不能确定最优利妥昔单抗方案,但在疗效方面,利妥昔单抗每次1 g,2周1次×2方案更具意义,安全性方面则B细胞滴定方案优于其他利妥昔单抗方案,但目前尚缺乏大规模、高质量、双盲的随机对照试验进行验证。
OBJECTIVE To evaluate the efficacy and safety of rituximab in the treatment of membranous nephropathy.METHODS Databases including PubMed,Embase,The Cochrane Library,Web of Science,Wanfang,CBM,CNKI data were searched for clinical trials on rituximab for membranous nephropathy from inception to January 12,2022.Stata 16.0 was used to conduct network Meta-analysis.RESULTS A total of 12 studies were included.The network Meta-analysis showed that in terms of complete remission rate,the optimal regimen was the rituximab 1 g per 2 weeks×2 regimen,followed by the ultra-low dose rituximab combination regimen,the 375 mg·m-2 once a week for two times combination regimen,the non-immunosuppressive therapy regimen,and the tacrolimus regimen;in terms of partial remission rate,the optimal regimen was the tacrolimus regimen,followed by the ultra-low dose rituximab combination regimen,the 375 mg·m-2 once a week for two times combination regimen,the 375 mg·m-2 once a week for six months combination regimen,and the rituximab 1g×1 combination regimen;in terms of safety,the glucocorticoid regimen was superior to the B-cell titration regimen,the standard four dose combination regimen,the tripterygium glycoside regimen,and the non-immunosuppressive treatment regimens.CONCLUSION The optimal rituximab regimen cannot be determined yet,but in terms of efficacy,the rituximab 1 g per 2 weeks×2 regimen is more meaningful,and in terms of safety,the B-cell titration regimen is superior to other rituximab regimens.However,there is still a lack of large-scale,high-quality,double-blind randomized controlled trials for validation.
作者
蓝秋梅
张涵清
周子钧
方雅萱
杨波
LAN Qiu-mei;ZHANG Han-qing;ZHOU Zi-jun;FANG Ya-xuan;YANG Bo(The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China;National Clinical Research Center of Chinese Medicine Acupuncture and Moxibustion,Tianjin 300193,China)
出处
《中国医院药学杂志》
CAS
北大核心
2023年第9期1029-1035,共7页
Chinese Journal of Hospital Pharmacy
基金
国家重点研发计划中医药现代化研究项目(编号:2019YFC1709400、2019YFC1709401)。
