治疗克罗恩病的非生物制剂疗效比较:基于网状Meta分析的比较结果

The Efficacy of Different Non-biological Agents in the Treatment of Crohn's Disease:the Evidence based on the Network Meta-analysis

目的系统评价不同非生物制剂治疗成人克罗恩病患者的疗效和安全性。方法计算机检索Pubmed、The Cochrane library、中国期刊全文数据库和万方数据知识服务平台数据库,搜集不同非生物制剂治疗成人克罗恩病患者的随机对照研究,检索时限均为建库至2021年7月。两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R3.6.1软件gemtc程序包进行贝叶斯网状Meta分析。结果共纳入21个研究,针对疗效指标诱导期缓解率的网状Meta分析结果显示:与安慰剂相比,6-巯基嘌呤、硫唑嘌呤、布地奈德、柳氮磺吡啶联用6-巯基嘌呤能显著提高诱导期缓解率。对于这10种干预措施排序可知,6-巯基嘌呤疗效最好的概率最大,奥沙拉嗪的概率最小。针对疗效指标维持期缓解率的网状Meta分析结果显示:与安慰剂相比,硫唑嘌呤能显著提高维持期缓解率。针对安全性指标依从性的网状Meta分析结果显示:与安慰剂相比,纳入的所有干预措施的依从性与安慰剂比较均无显著差异。对于这8种干预措施排序可知:依维莫司的依从性最好的概率最大,甲氨蝶呤的概率最小。结论现有证据表明,在成人克罗恩病的非生物制剂治疗中,6-巯基嘌呤在诱导期缓解效果更好,硫唑嘌呤在维持期缓解效果更好,而就依从性而言纳入的各干预措施无较大差别。

Objective To systematically evaluate the efficacy and safety of different non-biological agents combined in the treatment of patients with Crohn's disease.Methods Computer searched PubMed,The Cochrane Library,CNKI and WanFang Data databases to collect randomized controlled studies of different non-biological agents in the treatment of patients with Crohn's disease.The search time was from the establishment of the database to July 2021.Two reviewers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies.The R software gemtc package was used for Bayesian Network meta-analysis.Results A total of 21 studies were enrolled,network Meta-analysis results for the efficacy indicator induction remission showed that:compared with placebo,mercaptopurine,azathioprine,budesonide,sulfasalazine+mercaptopurine could significantly improve induction remission,the results ranking table showed that the probability of mercaptopurine ranking first was the highest,while the probability of olsalazine was the lowest.Network Meta-analysis of the efficacy indicator maintenance remission showed that azathioprine could significantly increase maintenance compared with placebo.In terms of safety,all the interventions included were not significantly different from placebo.The results ranking table showed that the probability of everolimus ranking first was the highest,while the probability of methotrexate was the lowest.Conclusion Existing evidence indicates that mercaptopurine had the best induction remission in patients with Crohn's disease,and the azathioprine had the best maintenance remission.In term of safety,all include interventions included were not significantly different from placebo.