Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, and Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
Clin Exp Rheumatol. 2020 Jul-Aug;38(4):783-791. Epub 2020 Jun 23.
Fluorinated steroids are largely the therapeutic approach of autoimmune mediated congenital heart block (CHB). We performed a meta-analysis to assess the efficacy of fluorinated steroids for the treatment of CHB.
Studies evaluating the efficacy of fluorinated steroids versus no treatment in CHB patients were identified in electronic databases. Random-effects model was used to pool odds ratio (OR) (with 95% CI) of live births as the primary outcome. ORs of CHB progression, pacemaker implantation and extranodal disease were the secondary outcome. Subgroup analysis according to CHB grade and study type was performed.
Data from nine studies involving 747 patients were analysed. The overall live birth rates were 86.8% and 86.7%, respectively, in the fluorinated steroids exposed foetuses and in the non-exposed ones. Fluorinated steroids did not ameliorate overall survival in CHB (OR 1.02; 95% CI: 0.65-1.61) with any significant statistical heterogeneity between studies (I2 0%, p=0.45). No significant differences for the progression of CHB, the pacing and the presence of extranodal disease were observed. Subgroup analysis revealed a significant protective role of fluorinated steroids for survival in 3rd degree CHB and for pacing in monocentric studies, OR 4.07; 95% CI: 1.10-15.08 and OR 0.15; 95% CI: 0.02-0.99, respectively.
This meta-analysis shows that fluorinated steroids are not superior to any treatment in patients with CHB in terms of live birth, prevention of progression of incomplete CHB, pacemaker implantation and extranodal disease. Thus, considering their side effects, their use in CHB patients should be discouraged.
氟代甾体主要用于治疗自身免疫性先天性心脏传导阻滞（CHB）。我们进行了一项荟萃分析，以评估氟代甾体治疗 CHB 的疗效。
在电子数据库中确定了评估氟代甾体与 CHB 患者无治疗相比疗效的研究。使用随机效应模型汇总活产的优势比（OR）（置信区间为 95%）作为主要结局。CHB 进展、起搏器植入和结外疾病的 OR 为次要结局。根据 CHB 分级和研究类型进行了亚组分析。
共纳入 9 项研究 747 例患者的数据进行分析。氟代甾体暴露胎儿和未暴露胎儿的总体活产率分别为 86.8%和 86.7%。氟代甾体并不能改善 CHB 的总体生存率（OR 1.02；95%CI：0.65-1.61），各研究之间无统计学异质性（I2 0%，p=0.45）。CHB 进展、起搏和结外疾病的发生率无显著差异。亚组分析显示氟代甾体对 3 度 CHB 生存率和单中心研究中起搏有显著保护作用，OR 分别为 4.07（95%CI：1.10-15.08）和 0.15（95%CI：0.02-0.99）。
本荟萃分析表明，氟代甾体在 CHB 患者的活产率、预防不完全 CHB 进展、起搏器植入和结外疾病方面并不优于任何治疗。因此，考虑到其副作用，应避免在 CHB 患者中使用。
