非甾体抗炎药治疗幼年特发性关节炎患者的疗效和安全性比较：一项系统评价和网状Meta分析

Comparative Efficacy and Safety of Non-Steroidal Anti-Inflammatory Drugs in Patients With Juvenile Idiopathic Arthritis: A Systematic Review and Network Meta-analysis.

作者信息

Shi Chun-Lian, Zhang Yu, Zhang Zhi-Yong, Zhou Juan, Tang Xue-Mei

机构信息

Department of Rheumatology and Immunology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, PR China.

出版信息

Indian Pediatr. 2021 Feb 15;58(2):162-168.

PMID:33632948

Abstract

OBJECTIVE

We conducted a systematic review and network meta-analysis to compare the efficacy and safety of nine non-steroidal anti-inflammatory drugs (NSAIDs) in treating patients with juvenile idiopathic arthritis (JIA).

METHODS

Randomized controlled trials (RCTs) of NSAIDs for the treatment in children with JIA were searched systematically by using MEDLINE, EMBASE, and the Cochrane Library for available literature up to January 1, 2019. Bayesian network meta-analysis was used to combine direct and indirect evidence on treatment effectiveness and safety.

RESULTS

Eight eligible RCTs involving 1112 patients with JIA were identified, addressing 9 interventions. The ranking probability plot based on the surface under the cumulative ranking curve (SUCRA) indicated that celecoxib (6 mg/kg twice-a-day) had the highest probability of being most effective (SUCRA = 76.4%) among four NSAIDs (celecoxib, rofecoxib, meloxicam, and naproxen). Also, rofecoxib (0.3 mg/kg once-a-day) and piroxicam demonstrated a higher probability of safety in treating children with JIA (SUCRA = 33.0% and 35.5%, respectively), compared with other interventions.

CONCLUSIONS

The quality of available evidence limits the formation of powerful conclusions regarding the comparative efficacy or safety of NSAIDs used to treat JIA.

摘要

目的

我们进行了一项系统评价和网状Meta分析，以比较九种非甾体抗炎药（NSAIDs）治疗幼年特发性关节炎（JIA）患者的疗效和安全性。

方法

通过检索MEDLINE、EMBASE和Cochrane图书馆，系统搜索截至2019年1月1日有关NSAIDs治疗儿童JIA的随机对照试验（RCT）的可用文献。采用贝叶斯网状Meta分析合并治疗有效性和安全性的直接和间接证据。

结果

共纳入8项合格的RCT，涉及1112例JIA患者，涵盖9种干预措施。基于累积排序曲线下面积（SUCRA）的排序概率图表明，在四种NSAIDs（塞来昔布、罗非昔布、美洛昔康和萘普生）中，塞来昔布（6mg/kg，每日两次）最有效的概率最高（SUCRA=76.4%）。此外，与其他干预措施相比，罗非昔布（0.3mg/kg，每日一次）和吡罗昔康在治疗JIA儿童时安全性概率更高（分别为SUCRA=33.0%和35.5%）。