Stagg H R, Harris R J, Hatherell H-A, Obach D, Zhao H, Tsuchiya N, Kranzer K, Nikolayevskyy V, Kim J, Lipman M C, Abubakar I
Research Department of Infection and Population Health, University College London, London, UK.
Statistics, Modelling and Economics Department, Public Health England, London, UK.
Thorax. 2016 Oct;71(10):940-9. doi: 10.1136/thoraxjnl-2015-208262. Epub 2016 Jun 13.
Consensus on the best treatment regimens for patients with isoniazid-resistant TB is limited; global treatment guidelines differ. We undertook a systematic review and meta-analysis using mixed-treatment comparisons methodology to provide an up-to-date summary of randomised controlled trials (RCTs) and relative regimen efficacy.
Ovid MEDLINE, the Web of Science and EMBASE were mined using search terms for TB, drug therapy and RCTs. Extracted data were inputted into fixed-effects and random-effects models. ORs for all possible network comparisons and hierarchical rankings for different regimens were obtained.
12 604 records were retrieved and 118 remained postextraction, representing 59 studies-27 standalone and 32 with multiple papers. In comparison to a baseline category that included the WHO-recommended regimen for countries with high levels of isoniazid resistance (rifampicin-containing regimens using fewer than three effective drugs at 4 months, in which rifampicin was protected by another effective drug at 6 months, and rifampicin was taken for 6 months), extending the duration of rifampicin and increasing the number of effective drugs at 4 months lowered the odds of unfavourable outcomes (treatment failure or the lack of microbiological cure; relapse post-treatment; death due to TB) in a fixed-effects model (OR 0.31 (95% credible interval 0.12-0.81)). In a random-effects model all estimates crossed the null.
Our systematic review and network meta-analysis highlight a regimen category that may be more efficacious than the WHO population level recommendation, and identify knowledge gaps where data are sparse.
PROSPERO CRD42014015025.
对于耐异烟肼结核病患者的最佳治疗方案，目前尚未达成共识；全球治疗指南存在差异。我们采用混合治疗比较方法进行了系统评价和荟萃分析，以提供随机对照试验（RCT）及相关治疗方案疗效的最新总结。
使用结核病、药物治疗和RCT的检索词，对Ovid MEDLINE、科学网和EMBASE进行检索。将提取的数据输入固定效应模型和随机效应模型。获得所有可能的网络比较的比值比（OR）以及不同治疗方案的层次排名。
共检索到12604条记录，提取后剩余118条，代表59项研究——其中27项为独立研究，32项有多篇论文。与一个基线类别相比，该基线类别包括世界卫生组织为异烟肼耐药率高的国家推荐的治疗方案（4个月使用少于三种有效药物的含利福平方案，其中利福平在6个月时由另一种有效药物保护，且利福平服用6个月），在固定效应模型中，延长利福平的疗程并增加4个月时有效药物的数量可降低不良结局（治疗失败或微生物未治愈；治疗后复发；结核病死亡）的几率（OR 0.31（95%可信区间0.12 - 0.81））。在随机效应模型中，所有估计值均穿过无效值。
我们的系统评价和网络荟萃分析突出了一种可能比世界卫生组织针对总体人群的推荐方案更有效的治疗方案类别，并确定了数据稀少的知识空白领域。
PROSPERO CRD42014015025。
Zotero 插件
