Bellos Ioannis, Boletis Ioannis, Lionaki Sophia
National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
Department of Nephrology and Transplantation, Laiko Hospital, Athens, Greece.
Kidney Int Rep. 2022 Mar 2;7(5):1074-1083. doi: 10.1016/j.ekir.2022.02.020. eCollection 2022 May.
To compare the efficacy and safety of different regimens used for maintenance of remission in patients with antineutrophil cytoplasmic antibody ANCA) vasculitis.
This network meta-analysis studied adult patients with ANCA vasculitis in complete remission, who were maintained with various regimens, excluding patients with eosinophilic granulomatosis with polyangiitis (GPA) and those who have ended up in end-stage kidney disease. Outcomes of interest included relapse (any/major), relapse-free survival, and adverse effects. PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar were systematically searched from inception.
Overall, the meta-analysis was based on 10 reports, describing the outcomes of 7 randomized controlled trials (RCTs) including 752 patients with ANCA vasculitis. Relapse-free survival was significantly worse with the use of azathioprine (hazard ratio [HR]: 2.11, 95% CI: 1.19-3.74), methotrexate (HR: 2.51, 95% CI: 1.24-5.08), and mycophenolate mofetil (HR: 3.57, 95% CI: 1.70-7.46) compared with the use of rituximab. Outcomes estimated for azathioprine (HR: 0.59, 95% CI: 0.37-0.94), cyclophosphamide (HR: 0.39, 95% CI: 0.20-0.75), and leflunomide (HR: 0.30, 95% CI: 0.11-0.84) were better than those for mycophenolate mofetil. When examining relapse-free survival, relapses were more likely with use of azathioprine (odds ratio [OR]: 2.15, 95% CI: 1.00-4.59) and mycophenolate mofetil (OR: 4.42, 95% CI: 1.63-11.94) compared with the use of rituximab. The risk of major relapse calculated for azathioprine (OR: 2.39, 95% CI: 1.10-5.19), methotrexate (OR: 3.18, 95% CI: 1.14-8.89), and mycophenolate mofetil (OR: 5.20, 95% CI: 1.65-16.37) was higher than that for rituximab. The rates of serious adverse effects did not differ significantly among interventions.
Rituximab appears predominant in maintaining remission in patients with ANCA vasculitis with no cost in adverse events.
比较不同方案用于抗中性粒细胞胞浆抗体（ANCA）血管炎患者缓解期维持治疗的疗效和安全性。
本网络荟萃分析研究了处于完全缓解期的成年ANCA血管炎患者，这些患者接受了各种方案的维持治疗，排除了嗜酸性肉芽肿性多血管炎（GPA）患者以及最终发展为终末期肾病的患者。感兴趣的结局包括复发（任何/主要）、无复发生存期和不良反应。从创刊起系统检索了PubMed、Scopus、科学网、Cochrane对照试验中心注册库（CENTRAL）、ClinicalTrials.gov和谷歌学术。
总体而言，荟萃分析基于10份报告，描述了7项随机对照试验（RCT）的结果，包括752例ANCA血管炎患者。与使用利妥昔单抗相比，使用硫唑嘌呤（风险比[HR]：2.11，95%置信区间[CI]：1.19 - 3.74）、甲氨蝶呤（HR：2.51，95% CI：1.24 - 5.08）和霉酚酸酯（HR：3.57，95% CI：1.70 - 7.46）时无复发生存期显著更差。硫唑嘌呤（HR：0.59，95% CI：0.37 - 0.94）、环磷酰胺（HR：0.39 , 95% CI：0.20 - 0.75）和来氟米特（HR：0.30，95% CI：0.11 - 0.84）的结局估计优于霉酚酸酯。在检查无复发生存期时，与使用利妥昔单抗相比，使用硫唑嘌呤（优势比[OR]：2.15，95% CI：1.00 - 4.59）和霉酚酸酯（OR：4.42，95% CI：1.63 - 11.94）时复发的可能性更大。硫唑嘌呤（OR：2.39，95% CI：1.10 - 5.19）、甲氨蝶呤（OR：3.18，95% CI：1.14 - 8.89）和霉酚酸酯（OR：5.20，95% CI：1.65 - 16.37）的主要复发风险高于利妥昔单抗。各干预措施的严重不良反应发生率无显著差异。
利妥昔单抗在维持ANCA血管炎患者缓解方面似乎占主导地位，且在不良事件方面无代价。
