Department of Medicine, McMaster University, Hamilton, Canada
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
BMJ. 2022 Feb 25;376:e064604. doi: 10.1136/bmj-2021-064604.
To assess the effects of plasma exchange on important outcomes in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV).
Systematic review and meta-analysis of randomised controlled trials.
Randomised controlled trials investigating effects of plasma exchange in patients with AAV or pauci-immune rapidly progressive glomerulonephritis and at least 12 months' follow-up.
Prior systematic reviews, updated by searching Medline, Embase, and CENTRAL to July 2020.
Reviewers independently identified studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool.
Meta-analyses were conducted using random effects models to calculate risk ratios and 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. Outcomes were assessed after at least12 months of follow-up and included all-cause mortality, end stage kidney disease (ESKD), serious infections, disease relapse, serious adverse events, and quality of life.
Nine trials including 1060 participants met eligibility criteria. There were no important effects of plasma exchange on all-cause mortality (relative risk 0.90 (95% CI 0.64 to 1.27), moderate certainty). Data from seven trials including 999 participants that reported ESKD demonstrated that plasma exchange reduced the risk of ESKD at 12 months (relative risk 0.62 (0.39 to 0.98), moderate certainty) with no evidence of subgroup effects. Data from four trials including 908 participants showed that plasma exchange increased the risk of serious infections at 12 months (relative risk 1.27 (1.08 to 1.49), moderate certainty). The effects of plasma exchange on other outcomes were uncertain or considered unimportant to patients.
There is a relative sparsity of events, and treatment effect estimates are therefore imprecise. Subgroup effects at the participant level could not be evaluated.
For the treatment of AAV, plasma exchange has no important effect on mortality, reduces the 12 month risk of ESKD, but increases the risk of serious infections.
No funding was received.
This is an update of a previously unregistered systematic review and meta-analysis published in 2014.
评估血浆置换对抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）重要结局的影响。
随机对照试验的系统评价和荟萃分析。
研究血浆置换对 AAV 或寡免疫性急进性肾小球肾炎患者影响的随机对照试验，且随访时间至少 12 个月。
先前的系统评价，更新检索了 Medline、Embase 和 Cochrane 中心数据库，截至 2020 年 7 月。
审查员独立识别研究，提取数据，并使用 Cochrane 偏倚风险工具评估偏倚风险。
荟萃分析采用随机效应模型计算风险比和 95%置信区间。根据 GRADE 方法总结证据质量。评估至少 12 个月随访后的结局，包括全因死亡率、终末期肾病（ESKD）、严重感染、疾病复发、严重不良事件和生活质量。
符合纳入标准的 9 项试验共纳入 1060 名参与者。血浆置换对全因死亡率无重要影响（相对风险 0.90（95%CI 0.64 至 1.27），证据质量为中等）。来自 7 项试验（共 999 名参与者）的数据显示，血浆置换可降低 12 个月时 ESKD 的风险（相对风险 0.62（0.39 至 0.98），证据质量为中等），且无亚组效应证据。来自 4 项试验（共 908 名参与者）的数据表明，血浆置换增加了 12 个月时严重感染的风险（相对风险 1.27（1.08 至 1.49），证据质量为中等）。关于其他结局，血浆置换的影响不确定或对患者不重要。
事件相对较少，因此治疗效果估计不精确。无法在参与者水平评估亚组效应。
对于 AAV 的治疗，血浆置换对死亡率无重要影响，降低 12 个月时 ESKD 的风险，但增加严重感染的风险。
无资金来源。
本次更新是 2014 年发表的一项先前未注册的系统评价和荟萃分析。
