利妥昔单抗治疗特发性膜性肾病的快速卫生技术评估

Rapid health technology assessment of rituximab in the treatment of idiopathic membranous nephropathy

目的:通过快速卫生技术评估(HTA)的方法,评价利妥昔单抗(RTX)治疗特发性膜性肾病(IMN)的有效性、安全性和经济性,为决策者提供证据参考。方法:检索PubMed、Cochrane Library、万方和中国知网等数据库,同时检索相关HTA网站及数据库。由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,对结果进行定性分析。结果:纳入系统评价/Meta分析14篇以及药物经济学研究3篇。有效性方面,利妥昔单抗在增加临床缓解率、血白蛋白水平、肾小球滤过率,及在降低尿蛋白、血肌酐、复发率等方面具有一定优势;安全性方面,RTX不良反应发生率较低且症状较轻;经济性方面,尽管单剂量RTX成本相对较高,但随着愿意支付阈值(WTP)的增加,RTX会更具成本-效果优势。结论:RTX治疗IMN具有较好的有效性和安全性,是一种中长期的经济有效的治疗方法。

Objective:To evaluate the efficacy,safety,and economy of rituximab(RTX)in the treatment of idiopathic membranous nephropathy(IMN)through rapid health technology assessment(HTA),and to provide evidence for decision makers.Methods:Retrieve databases such as PubMed,Cochrane Library,Wanfang,and CNKI,as well as relevant HTA websites and databases were searched.Two researchers independently selected literature,extracted data,and evaluated the quality based on inclusion and exclusion criteria,and then conducted qualitative analysis of the results.Results:Fourteen papers in systematic evaluation/Meta analysis and 3 papers in pharmacoeconomics research were included.In terms of effectiveness,rituximab had certain advantages in increasing clinical remission rate,blood albumin level,glomerular filtration rate,and reducing urinary protein,blood creatinine,and recurrence rate.In terms of safety,the incidence of adverse reactions in RTX was low and the symptoms were mild.In terms of economy,although the cost of single dose RTX was relatively high,as the willingness to pay threshold(WTP)increased,RTX had a more cost-effective advantage.Conclusion:RTX treatment for IMN has good efficacy and safety,and is a medium to long-term and economically effective treatment method.