免疫球蛋白用于治疗疼痛性周围神经病变：一项系统评价和荟萃分析。

Immunoglobulin Use for the Management of Painful Peripheral Neuropathy: A Systematic Review and Meta-Analysis.

作者信息

Zis Panagiotis, Liampas Andreas, Pozotou Theodora, Parperis Konstantinos, Artemiadis Artemios, Hadjigeorgiou Georgios

机构信息

Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Medical School, University of Cyprus, Nicosia, Cyprus.

出版信息

Pain Ther. 2022 Dec;11(4):1219-1227. doi: 10.1007/s40122-022-00416-7. Epub 2022 Aug 4.

DOI:10.1007/s40122-022-00416-7

PMID:35925489

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9633877/

Abstract

BACKGROUND

Immunoglobulins (IG) are widely used for the treatment of a variety of immune-mediated diseases. The exact mechanism of action remains unknown, but IG modulate the expression and function of Fc receptors, interfere with complement activation and production of cytokines, neutralize pathogenic autoantibodies, and affect the activation and effector functions of B and T lymphocytes. Immunoglobulins are usually delivered intravenously, and are effective in ameliorating motor symptoms, and/or preventing disease progression in immune-mediated neuropathies, including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy.

OBJECTIVE

The aim of this systematic review and meta-analysis was to study the potential of IG for the treatment of painful peripheral neuropathy (PPN). The outcome of interest was the percentage of patients with PPN who achieved pain relief following IG administration.

METHODS

We performed a systematic literature search on March 17, 2022, in the PubMed database without any publication date restrictions. We also looked for unpublished or ongoing trials in clinicaltrials.org. Pain reduction following IG treatment had to be within the aims (primary or secondary).

RESULTS

The aforementioned literature search strategy revealed five studies (two open-label, three randomized placebo-controlled) eligible to be included. The pooled estimate of the percentage of patients with PPN who received immunoglobulins and reported pain relief was found to be 65% (95% CI 58-71%). The likelihood of achieving pain relief with immunoglobulin treatment was 2.9 times higher (95% CI 1.6-5.2) compared to placebo (p = 0.0003).

CONCLUSION

The use of IG for the treatment of pain due to peripheral neuropathy has a potential therapeutic benefit. Further studies across patients with different types of painful peripheral neuropathy are needed to better characterize this effect. Registration number on PROSPERO: CRD42022319614.

摘要

背景

免疫球蛋白（IG）被广泛用于治疗多种免疫介导的疾病。其确切作用机制尚不清楚，但IG可调节Fc受体的表达和功能，干扰补体激活和细胞因子产生，中和致病性自身抗体，并影响B和T淋巴细胞的激活及效应功能。免疫球蛋白通常通过静脉给药，对改善运动症状和/或预防免疫介导的神经病变（包括吉兰-巴雷综合征和慢性炎症性脱髓鞘性多发性神经病）的疾病进展有效。

目的

本系统评价和荟萃分析的目的是研究IG治疗疼痛性周围神经病（PPN）的潜力。感兴趣的结局是PPN患者在接受IG治疗后实现疼痛缓解的百分比。

方法

我们于2022年3月17日在PubMed数据库中进行了系统的文献检索，无任何出版日期限制。我们还在clinicaltrials.org上查找未发表或正在进行的试验。IG治疗后的疼痛减轻必须在目标范围内（主要或次要）。

结果

上述文献检索策略共筛选出五项符合纳入标准的研究（两项开放标签研究，三项随机安慰剂对照研究）。接受免疫球蛋白治疗并报告疼痛缓解的PPN患者百分比的合并估计值为65%（95%CI 58-71%）。与安慰剂相比，免疫球蛋白治疗实现疼痛缓解的可能性高2.9倍（95%CI 1.6-5.2）（p = 0.0003）。