Adler Marcel, Herrera-Gómez Francisco, Martín-García Débora, Gavid Marie, Álvarez F Javier, Ochoa-Sangrador Carlos
Center for Medical Oncology & Hematology, Hospital Thun, 3600 Thun, Switzerland.
Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain.
Pharmaceuticals (Basel). 2020 Apr 30;13(5):85. doi: 10.3390/ph13050085.
After relative erythropoietin deficiency, iron deficiency is the second most important contributing factor for anemia in chronic kidney disease (CKD) patients. Iron supplementation is a crucial part of the treatment of anemia in CKD patients, and intravenous (IV) iron supplementation is considered to be superior to per os (PO) iron supplementation. The differences between the available formulations are poorly characterized. This report presents results from pairwise and network meta-analyses carried out after a comprehensive search in sources of published and unpublished studies, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations (International prospective register of systematic reviews PROSPERO reference ID: CRD42020148155). Meta-analytic calculations were performed for the outcome of non-response to iron supplementation (i.e., hemoglobin (Hgb) increase of <0.5-1.0 g/dL, or initiation/intensification of erythropoiesis-stimulating agent (ESA) therapy, or increase/change of iron supplement, or requirements of blood transfusion). A total of 34 randomized controlled trials (RCT) were identified, providing numerical data for analyses covering 93.7% (n = 10.097) of the total study population. At the network level, iron supplementation seems to have a more protective effect against the outcome of non-response before the start of dialysis than once dialysis is initiated, and some preparations seem to be more potent (e.g., ferumoxytol, ferric carboxymaltose), compared to the rest of iron supplements assessed (surface under the cumulative ranking area (SUCRA) > 0.8). This study provides parameters for adequately following-up patients requiring iron supplementation, by presenting the most performing preparations, and, indirectly, by making it possible to identify good responders among all patients treated with these medicines.
在相对促红细胞生成素缺乏之后，缺铁是慢性肾脏病（CKD）患者贫血的第二大重要促成因素。铁剂补充是CKD患者贫血治疗的关键部分，静脉注射（IV）铁剂补充被认为优于口服（PO）铁剂补充。现有制剂之间的差异鲜有描述。本报告展示了根据系统评价和Meta分析的首选报告项目（PRISMA）建议（国际系统评价前瞻性注册库PROSPERO注册号：CRD42020148155），在对已发表和未发表研究来源进行全面检索后开展的成对Meta分析和网状Meta分析的结果。针对铁剂补充无反应的结局进行Meta分析计算（即血红蛋白（Hgb）升高<0.5 - 1.0 g/dL，或启动/强化促红细胞生成素刺激剂（ESA）治疗，或增加/更换铁剂补充，或需要输血）。共识别出34项随机对照试验（RCT），提供了涵盖总研究人群93.7%（n = 10,097）的分析数值数据。在网状水平上，与开始透析后相比，在开始透析前铁剂补充似乎对无反应结局具有更强的保护作用，并且与评估的其他铁剂补充剂相比，一些制剂似乎更有效（例如，铁羧麦芽糖、羧基麦芽糖铁）（累积排序曲线下面积（SUCRA）> 0.8）。本研究通过展示效果最佳的制剂，以及间接通过在所有接受这些药物治疗的患者中识别出良好反应者，为需要铁剂补充的患者提供了充分随访的参数。
