生物制剂对中重度特应性皮炎短期达标治疗的有效性和安全性网状meta分析

Effectiveness and safety of biologics in short-term reaching-standard treatment ofmoderate to severe atopic dermatitis: a mesh meta analysis

目的采用网状meta分析比较不同生物制剂对中重度特应性皮炎(AD)患者的短期达标治疗的有效性和安全性。方法检索中国知网、中国生物医学文献数据库、万方、维普、PubMed、Cochrane Library、Embase数据库中的随机对照试验(RCT)研究,检索时间为各数据库建库至2023年8月,收集生物制剂治疗中重度AD的相关文献。按照纳入排除标准筛选文献、评价文献质量、提取数据资料后,采用RevMan5.3和Stata16.0软件进行网状meta分析。结果共检索到754篇文献,最终纳入11篇文献,涉及14项RCT研究,总样本量为5099例。共涉及4种干预方式,包含安慰剂和3种药物。3种药物分别是度普利尤单抗、来瑞组单抗、曲罗芦单抗。结果表明,每一项有效性指标中,不同的用药方案有不同的表现,综合达标治疗指标后,度普利尤单抗优于来瑞组单抗,来瑞组单抗优于曲罗芦单抗。不良反应方面,3种药物与安慰剂间比较,差异均无统计学意义(P>0.05)。结论度普利尤单抗是目前针对短期达标治疗最有效的生物制剂选择,可减轻炎症反应,改善皮肤症状。未来的研究应进一步评估其长期效果和安全性,以指导临床应用。

Objective To employ the mesh meta analysis to compare the effectiveness and safety of short-term reaching-standard treatment in the patients with moderate to severe atopic dermatitis among the different biologics.Methods The randomized controlled trials(RCT)were retrieved from the databases of CNKI,Chinese Biomedical Literature Database,Wanfang,VIP,PubMed,Cochrane Library and Embase databases.The retrieval time was from the database establishment to August,2023.The related literatures on the biologics for treating moderate to severe atopic dermatitis were collected.The literatures were screened by the inclusion and exclusion standards,the literature quality was evaluated and the data were extracted.Then the mesh meta analysis was performed by using RevMan 5.3 and Stata 16.0 softwares.Results A total of 754 articles were retrieved,and 11 articles were finally included,involving in 14 RCT with a total sample number of 5528 cases.There were 4 intervention methods,including placebo and 3 kinds of drugs.The drugs were Dupilumab,Lebrikizumab and Tralokinumab.The results showed that for each of effectiveness indicator,different medication regimens had different performance,after comprehensively meeting the treatment criteria,Dupriuliumab was superior to Lebrikizumab,and Lebrikizumab was superior to Tralokinumab.There was no statistical difference in adverse reactions between the three drugs and placebo(P>0.05).Conclusion Dupilumab is currently the most effective biologic agent for short-term target treatment,capable of reducing inflammation and improving skin symptoms.Future studies should further evaluate its long-term efficacy and safety to guide clinical application.