美托洛尔基于循证的药物评价

Evidence-based Drug Evaluation for Metoprolol

目的:借鉴世界卫生组织及各国遴选基本药物时所依据的循证方法,对我国2009年版《国家基本药物目录》中美托洛尔进行综合评价,探索适合我国国情的基本药物遴选路径及评价方法。方法:采用系统评价方法,对美托洛尔的疗效及安全性进行评价。结果:共纳入4篇文献,分析结果显示:与安慰剂相比,美托洛尔虽然不良反应发生率偏高[RR=5.39,95%C(I2.11,13.80),P=0.0004],但不增加死亡风险[RR=0.84,95%C(I0.52,1.35),P=0.47],且能显著降低心律失常复发率[RR=0.70,95%C(I0.61,0.82),P<0.00001]。结论:按系统评价流程,结合经济学研究满足基本药物遴选安全、有效、经济的要求,值得推广。

ABSTRACT Objective： To make a comprehensive estimation of metoprolol in the 2009 edition of the National Essential Drug Li.st with the reference of the evidence-based drug evaluation method for the selection of essential medicines by WHO and other countries, and to explore the way for the selection and evaluation of essential medicines according to the situation of China. Methods： A systematic evaluation method was used to estimate the efficacy and safety of metoprolol. Results： Four papers were enrolled in the analysis. The results indicated that compared with placebo, metoprolol caused more incidence of adverse reactions [RR = 5.39,95% CI （2.11,13.80）, P = 0.000 4], but it didn＇t increase the risk of mortality [RR = 0.84, 95% CI （0.52,1.35）, P = 0.47]. In addition, metoprolol can significantly reduce arrhythmia recurrence [RR = 0.70, 95% CI （0.61, 0.82）, P 〈0.000 01]. Conclusion： The systematic evaluation process combining with pharmacoeconomic study can be used for the selection of essential medicines and meet the requirements of safety, effectiveness and economy. It is worthy of promotion.