Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medicine, Chicago, IL.
Department of Medicine, Baptist Health System, San Antonio, TX.
J Clin Gastroenterol. 2018 Aug;52(7):596-606. doi: 10.1097/MCG.0000000000000878.
In order to provide a comparative evaluation of available pharmacologic treatments for eosinophilic esophagitis (EoE), we conducted a network meta-analysis.
A variety of pharmacologic treatments for EoE have been reported, however there exists a paucity of direct comparisons.
We searched randomized controlled trials using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials database through December 2014. Studies were analyzed using a random-effects network meta-analysis to identify the most effective therapy. Subgroup analysis was performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and also among pediatric and adult populations. The ranking probability for the efficacy of each treatment was analyzed. Consistency of the included randomized controlled trials was checked by applying inconsistency and node-splitting models.
Eleven studies of a total of 456 patients were identified. Six pharmacologic treatments (budesonide suspension and viscous, fluticasone, prednisone, esomeprazole, and mepolizumab) and placebo were included in our analysis. Meta-analysis showed superiority of budesonide viscous, budesonide suspension, and fluticasone over placebo. Network meta-analysis demonstrated the rank order of efficacy as budesonide viscous, esomeprazole, prednisone, budesonide suspension, fluticasone, mepolizumab, and placebo. The results were consistent from the inconsistency model analysis and node-splitting analysis. Subgroup analysis demonstrated prednisone, budesonide suspension, and esomeprazole were the most effective when network meta-analyses were performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and among pediatric and adult populations, respectively.
On the basis of this network meta-analysis, viscous budesonide was shown to be the most effective pharmacologic therapy for EoE among the reported pharmacologic treatments.
为了对嗜酸性粒细胞性食管炎（EoE）的现有药物治疗进行比较评估，我们进行了一项网络荟萃分析。
已经报道了多种治疗 EoE 的药物，但缺乏直接比较。
我们通过 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册数据库搜索了截至 2014 年 12 月的随机对照试验。使用随机效应网络荟萃分析来确定最有效的治疗方法，分析这些研究。在排除胃食管反流病或质子泵抑制剂反应性食管嗜酸性粒细胞增多症的研究中进行了亚组分析，还在儿科和成人人群中进行了亚组分析。分析了每种治疗方法的疗效排名概率。通过应用不一致性和节点分裂模型检查纳入的随机对照试验的一致性。
共确定了 11 项总计 456 例患者的研究。我们的分析包括 6 种药物治疗（布地奈德混悬液和粘性剂、氟替卡松、泼尼松、埃索美拉唑和美泊利珠单抗）和安慰剂。荟萃分析显示布地奈德粘性剂、布地奈德混悬液和氟替卡松优于安慰剂。网络荟萃分析显示，疗效排名顺序为布地奈德粘性剂、埃索美拉唑、泼尼松、布地奈德混悬液、氟替卡松、美泊利珠单抗和安慰剂。不一致性模型分析和节点分裂分析的结果一致。亚组分析表明，当在排除胃食管反流病或质子泵抑制剂反应性食管嗜酸性粒细胞增多症的研究中，以及在儿科和成人人群中进行网络荟萃分析时，泼尼松、布地奈德混悬液和埃索美拉唑是最有效的治疗方法。
根据这项网络荟萃分析，粘性布地奈德是报道的药物治疗中治疗 EoE 最有效的药物治疗方法。
