Webster Angela C, Playford E Geoffrey, Higgins Gail, Chapman Jeremy R, Craig Jonathan C
Cochrane Renal Group, Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.
Transplantation. 2004 Jan 27;77(2):166-76. doi: 10.1097/01.TP.0000109643.32659.C4.
Interleukin 2 receptor antagonists (IL-2Ra) are increasingly used to treat renal transplant recipients. This study aims to systematically identify and summarize the effects of using IL-2Ra as induction immunosuppression, as an addition to standard therapy, or as an alternative to other antibody therapy.
Databases, reference lists, and abstracts of conference proceedings were searched extensively to identify relevant randomized controlled trials in all languages. Data were synthesized using the random effects model. Results are expressed as relative risk (RR), with 95% confidence intervals (CI).
A total of 117 reports from 38 trials involving 4,893 participants were included. When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or 3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10 trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials: RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were not significantly different. When IL-2Ra were compared with other antibody therapy, no significant differences in treatment effects were demonstrated, but IL-2Ra had significantly fewer side effects.
Given a 40% risk of rejection, seven patients would need treatment with IL-2Ra in addition to standard therapy, to prevent one patient from undergoing rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab.
白细胞介素2受体拮抗剂（IL-2Ra）越来越多地用于治疗肾移植受者。本研究旨在系统地识别和总结将IL-2Ra用作诱导免疫抑制、作为标准治疗的附加治疗或替代其他抗体治疗的效果。
广泛检索数据库、参考文献列表和会议论文摘要，以识别所有语言的相关随机对照试验。使用随机效应模型合成数据。结果以相对风险（RR）表示，并给出95%置信区间（CI）。
共纳入38项试验的117份报告，涉及4893名参与者。当将IL-2Ra与安慰剂进行比较时（17项试验；2786例患者），1年时移植肾丢失无显著差异（14项试验：RR 0.84；CI 0.64 - 1.10）或3年时（4项试验：RR 1.08；CI 0.71 - 1.64）。6个月时急性排斥反应显著降低（12项试验：RR 0.66；CI 0.59 - 0.74），1年时（10项试验：RR 0.67；CI 0.60 - 0.75）也是如此。1年时，巨细胞病毒感染（7项试验：RR 0.82；CI 0.65 - 1.03）和恶性肿瘤（9项试验：RR 0.67；CI 0.33 - 1.36）无显著差异。当将IL-2Ra与其他抗体治疗进行比较时，未显示治疗效果有显著差异，但IL-2Ra的副作用明显较少。
鉴于有40%的排斥风险，除标准治疗外，7名患者需要接受IL-2Ra治疗，以防止1名患者发生排斥反应，移植肾或患者生存率无明显改善。巴利昔单抗和达利珠单抗之间无明显差异。
