Li Ying, Gao Jie, Wang Qiwei, Ma Xiaojian
Department of Paediatrics, Huaihe Hospital, Henan University, Kaifeng 475000, Henan, China.
Oncotarget. 2017 Sep 14;8(46):81167-81175. doi: 10.18632/oncotarget.20882. eCollection 2017 Oct 6.
The paper aimed to evaluate the efficacy of different therapies in improving survival among preterm infants.
PubMed and Embase were searched from inception to 2017. We assessed studies for eligibility and extracted data. A Bayesian random-effects model was used to evaluate different therapies combined direct comparisons with indirect evidence. Consistency analysis was achieved using node-splitting plots. Surface under the cumulative ranking curve (SUCRA) was calculated to rank different therapies. Rankings of the competing therapies were also performed.
A total of 42 randomized controlled trials (RCTs) were included for the network meta-analysis. Forest plots demonstrated that dexamethasone (OR = 10.13, 95% CrI: 5.11 to 17.89) and vitamin A (OR = 28.44, 95% CrI: 14.66 to 42.11) is superior to placebo in duration of oxygen supplementation while vitamin A (OR = -29.76, 95% CrI: -57.66 to -1.75) is inferior to placebo with regard to duration of hospitalization. Also, dexamethasone (OR = 0.42, 95% CrI: 0.24 to 0.68) showed lower incidence rate of BPD.SUCRA results showed the superiority of Budesonide based on primary efficacy outcomes. In addition, dexamethasone also showed high efficacy ranking in duration of ventilation, duration of oxygen supplementation, and occurrence of BPD. Hydrocortisone was effective in reducing neonatal mortality. No significant difference was found among these drugs.
No significant heterogeneity was found among these drugs. In general, budesonide might have the potential to be the optimal drug for its efficacy in reducing neonatal mortality and BPD, the two most essential outcome measures. Dexamethasone might be the suboptimal drug.
本文旨在评估不同疗法对提高早产儿生存率的疗效。
检索了自数据库建库至2017年的PubMed和Embase。我们评估研究的纳入资格并提取数据。采用贝叶斯随机效应模型，结合直接比较和间接证据来评估不同疗法。使用节点拆分图进行一致性分析。计算累积排序曲线下面积（SUCRA）以对不同疗法进行排名。还对竞争疗法进行了排名。
共纳入42项随机对照试验（RCT）进行网络荟萃分析。森林图显示，地塞米松（OR = 10.13，95% CrI：5.11至17.89）和维生素A（OR = 28.44，95% CrI：14.66至42.11）在吸氧持续时间方面优于安慰剂，而维生素A（OR = -29.76，95% CrI：-57.66至-1.75）在住院时间方面不如安慰剂。此外，地塞米松（OR = 0.42，95% CrI：0.24至0.68）显示支气管肺发育不良（BPD）的发生率较低。SUCRA结果显示基于主要疗效指标布地奈德具有优越性。此外，地塞米松在通气持续时间、吸氧持续时间和BPD发生率方面也显示出高疗效排名。氢化可的松在降低新生儿死亡率方面有效。这些药物之间未发现显著差异。
这些药物之间未发现显著异质性。总体而言，布地奈德因其在降低新生儿死亡率和BPD这两个最重要的结局指标方面的疗效，可能有潜力成为最佳药物。地塞米松可能是次优药物。
