Center for Primary Care and Outcomes Research and Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
BMJ. 2012 Oct 22;345:e6512. doi: 10.1136/bmj.e6512.
To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in the evidence with network analysis.
Systematic review and network analysis.
Cochrane Central Register of Controlled Trials and PubMed from inception to 31 August 2011.
Randomised controlled trials that examined treatment of 16 neglected tropical diseases or complications thereof published in English, French, Spanish, Portuguese, German, or Dutch.
We identified 971 eligible randomised trials. Leishmaniasis (184 trials, 23,039 participants) and geohelminth infections; 160 trials, 46,887 participants) were the most studied, while dracunculiasis (nine trials, 798 participants) and Buruli ulcer (five trials, 337 participants) were least studied. Relative to its global burden of disease, lymphatic filariasis had the fewest trials and participants. Only 11% of trials were industry funded. Either a single trial or trials with fewer than 100 participants comprised the randomised evidence for first or second line treatments for Buruli ulcer, human African trypanosomiasis, American trypanosomiasis, cysticercosis, rabies, echinococcosis, New World cutaneous leishmaniasis, and each of the foodborne trematode infections. Among the 10 disease categories with more than 40 trials, five lacked sufficient head to head comparisons between first or second line treatments.
There is considerable variation in the amount of evidence from randomised controlled trials for each of the 16 major neglected tropical diseases. Even in diseases with substantial evidence, such as leishmaniasis and geohelminth infections, some recommended treatments have limited supporting data and lack head to head comparisons.
评估治疗主要被忽视热带病的随机对照试验的证据数量和分布，并通过网络分析确定证据中的空白。
系统评价和网络分析。
Cochrane 对照试验中心注册库和 PubMed，检索时间从建库至 2011 年 8 月 31 日。
评估了 16 种被忽视热带病或其并发症的治疗方法的英语、法语、西班牙语、葡萄牙语、德语或荷兰语发表的随机对照试验。
我们确定了 971 项合格的随机试验。利什曼病（184 项试验，23039 名参与者）和肠道蠕虫感染（160 项试验，46887 名参与者）研究最多，而麦地那龙线虫病（9 项试验，798 名参与者）和布鲁里溃疡（5 项试验，337 名参与者）研究最少。相对于其全球疾病负担，淋巴丝虫病的试验和参与者最少。只有 11%的试验是由工业界资助的。仅有一项试验或参与者少于 100 人的试验构成了布鲁里溃疡、人类非洲锥虫病、美洲锥虫病、囊尾蚴病、狂犬病、包虫病、新出现的皮肤利什曼病和每种食源性吸虫感染的一线或二线治疗的随机证据。在有 40 多项试验的 10 个疾病类别中，有 5 个缺乏一线或二线治疗之间足够的头对头比较。
16 种主要被忽视热带病的随机对照试验证据数量存在很大差异。即使在利什曼病和肠道蠕虫感染等有大量证据的疾病中，一些推荐的治疗方法也缺乏数据支持，并且缺乏头对头比较。
