Comparative efficacy and safety of alternative glucocorticoids regimens in patients with ANCA-associated vasculitis: a systematic review.

Autor:	Xiao Y; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada xiaoyingqixyq@163.com.; West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Guyatt G; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Zeng L; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Pharmacy Department/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China., Rw Jayne D; Department of Medicine, University of Cambridge, Cambridge, UK., A Merkel P; Division of Rheumatology, Department of Medicine and Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Ac Siemieniuk R; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Dookie JE; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., A Buchan T; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada., Ahmed MM; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada., J Couban R; DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada., Mahr A; Clinic for Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland., Walsh M; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Population Health Research Institute, Hamilton Health Sciences / McMaster University, Hamilton, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Feb 25; Vol. 12 (2), pp. e050507. Date of Electronic Publication: 2022 Feb 25.
DOI:	10.1136/bmjopen-2021-050507
Abstrakt:	Objective: To compare the efficacy and safety of alternative glucocorticoids (GCs) regimens as induction therapy for patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. Design: Systematic review of randomised controlled trials (RCTs). Data Sources: Medline, Embase, Clinicaltrials.gov and Cochrane Central Register of Controlled Trials up to 10 April 2020. Study Selection and Review Methods: RCTs comparing two (or more) different dose regimens of GC in ANCA-associated vasculitis during induction of remission, regardless of other therapies. Pairs of reviewers independently screened records, extracted data and assessed risk of bias. Two reviewers rated certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Of 3912 records identified, the full texts of two records met the eligibility criteria. Due to the heterogeneity of population and dose regimen of GCs between the two trials, we descriptively presented the two trials and did not combine the results using meta-analysis. Compared with the standard-dose regimen, the reduced-dose regimen of GC may reduce death risk difference (RD): from -1.7% to -2.1%, low certainty), while not increasing end-stage kidney disease (ESKD) (RD: from -1.5% to 0.4%, moderate certainty). The reduced-dose regimen probably has an important reduction in serious infections at 1 year (RD: from -12.8% to -5.9%, moderate certainty). Reduced-dose regimen of GCs probably has trivial or no effect in disease remission, relapse or health-related quality of life (moderate to high certainty). Conclusions: The reduced-dose regimen of GC may reduce death at the follow-up of 6 months to longer than 1 year and serious infections while not increasing ESKD. Prospero Registration Number: CRD42020179087. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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