达沙替尼治疗慢性髓细胞性白血病的快速卫生技术评估

Dasatinib for Chronic Myelogenous Leukemia:A Rapid Health Technology Assessment

目的利用快速卫生技术评估(health technology assessment,HTA)方法,评估达沙替尼治疗伊马替尼耐药/不耐受的慢性髓细胞性白血病(chronic myelogenous leukemia,CML)患者的有效性、安全性和经济性,为临床药物选择提供科学的证据支持。方法通过计算机检索PubMed、Embase、Cochrane Library和知网(CNKI)、万方数据库。由2名评价员根据纳入、排除标准独立检索、筛选和提取数据结果,对结果进行定性分析。结果共纳入1篇HTA报告,2篇系统评价/meta分析,9篇药物经济学研究。使用达沙替尼治疗伊马替尼耐药/不耐受的CML患者可以更快地产生细胞应答,使更多患者从中获益,减少疾病进展,并获得更长的生存期。其不良反应主要为中性粒细胞减少、血小板减少等。达沙替尼、尼洛替尼与大剂量伊马替尼相比可以延长患者质量调整生命年,并具有较好的成本效果。结论达沙替尼治疗伊马替尼耐药/不耐受的CML患者具有良好的有效性、安全性,经济性优于大剂量伊马替尼但是较尼洛替尼差。

OBJECTIVE To analyze the effectiveness,safety and economy of dasatinib in chronic myelogenous leukemia(CML)patients with imatinib-resistant or-intolerant by health technology assessment(HTA),so as to provide currently available best scientific evidence for medication selection.METHODS The study included a systematic literature search for studies published in PubMed,Embase,Cochrane Library,CNKI and Wan Fang databases.Two reviewer independently retrieved,screened and extracted data results based on inclusion and exclusion criteria.RESULTS A HTA report,two systematic review/meta-analysis and nine cost-effective studies were finally included.The use of dasatinib in the treatment of imatinib-resistant or-intolerant CML patients to induce faster and deeper molecular responses and reduce disease progression,so that more patients benefit from it.Besides,the main adverse reactions were neutropenia,thrombocytopenia and so on.Dadatinib and nilotinib could prolong the quality-adjusted life year and had better cost-effectiveness compared with high-dose imatinib.CONCLUSION Dasatinib is an effective,safe in the treatment of imatinib-resistant/-intolerant CML patients.And the economy was better than the high dose of imatinib but worse than nilotinib.