4种膜性肾病治疗药物的快速卫生技术评估
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篇名: 4种膜性肾病治疗药物的快速卫生技术评估
TITLE: Rapid health technology assessment of 4 kinds of drugs for membranous nephropathy
摘要: 目的 比较他克莫司(TAC)、环孢素A(CsA)、环磷酰胺(CTX)、利妥昔单抗(RTX)治疗膜性肾病(MN)的有效性、安全性和经济性。方法计算机检索Pubmed、theCochraneLibrary、万方数据、中国知网和国内外卫生技术评估(HTA)机构官方网站,收集TAC、CsA、CTX、RTX联合糖皮质激素治疗MN的HTA报告、系统评价/Meta分析和药物经济学研究,检索时限均为建库起至2022年3月。在资料提取和质量评价后,对纳入研究的结果进行描述性分析。结果共纳入了15篇文献,其中13篇为系统评价/Meta分析,2篇为药物经济学研究。有效性方面,TAC、CsA在增加缓解率方面具有显著优势,能改善尿蛋白、血清白蛋白、血清肌酐、血清总胆固醇水平。安全性方面,TAC、CsA、RTX的不良反应发生率较低且症状较轻。经济学方面,CTX的成本较低但不良反应严重,TAC单剂量成本较高但缓解率较高,安全性较好。结论TAC联合糖皮质激素可能是用于MN的推荐方案。
ABSTRACT: OBJECTIVE To compare the efficacy, safety and economy of tacrolimus (TAC), cyclosporin A (CsA), cyclophosphamide (CTX) and rituximab (RTX) in the treatment of membranous nephropathy (MN). METHODS Retrieved from Pubmed, the Cochrane Library, Wanfang data, CNKI and health technology assessment (HTA) official website, HTA reports, systematic reviews/meta-analysis and pharmacoeconomic studies about TAC, CsA, CTX and RTX combined with glucocorticoid in the treatment of MN were collected during the inception and Mar. 2022. After data extraction and quality evaluation, descriptive analysis was performed on the results of the included studies. RESULTS A total of 15 articles were included, involving 13 systematic reviews/meta-analysis and 2 pharmacoeconomic studies. In terms of efficacy, TAC and CsA showed significant advantages in increasing the response rate, and could improve the levels of urine protein, serum albumin, serum creatinine and serum total cholesterol. In terms of safety, the incidence of adverse reaction induced by TAC, CsA and RTX was low and the symptoms were mild. In terms of economics, CTX cost lower but caused severe adverse reaction; TAC cost higher but showed higher remission rate and good safety. CONCLUSIONS TAC combined with glucocorticoid may be the recommended scheme for MN.
期刊: 2023年第34卷第08期
作者: 张圣雨;舒赖心玥;朱鹏里;宁丽娟;陈泳伍;吴菲;吴颖其;沈爱宗
AUTHORS: ZHANG Shengyu,SHU Laixinyue,ZHU Pengli,NING Lijuan,CHEN Yongwu,WU Fei,WU Yingqi,SHEN Aizong
关键字: 快速卫生技术评估;膜性肾病;环孢素A;他克莫司;环磷酰胺;利妥昔单抗
KEYWORDS: rapid health technology assessment; membranous nephropathy; cyclosporine A; tacrolimus; cyclophosphamide;
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