Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000, Jiangsu Province, China.
Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000, Jiangsu Province, China.
Int Urol Nephrol. 2023 Mar;55(3):631-640. doi: 10.1007/s11255-022-03353-8. Epub 2022 Sep 7.
The objective of this meta-analysis was to compare the efficacy and drug safety of tolvaptan with placebo for autosomal dominant polycystic kidney disease (ADPKD).
The PubMed, Embase, and Cochrane Library databases were searched from inception to September 10, 2021. Eligible studies comparing tolvaptan and placebo in the treatment of patients with ADPKD were included. Data were analysed using Review Manager Version 5.3.
Thirteen studies involving 3575 patients were included in the meta-analysis. Compared with placebo, tolvaptan had a better effect on delaying eGFR decline (MD 1.27, 95% CI 1.24-1.29, P < 0.01) and TKV increase (MD - 3.01, 95% CI - 3.55 to - 2.47, P < 0.01) in ADPKD treatment. Additionally, tolvaptan reduced the incidence of complications such as renal pain (OR 0.71, 95% CI 0.58-0.87, P < 0.01), urinary tract infection (OR 0.69, 95% CI 0.54-0.89, P < 0.01), haematuria (OR 0.68, 95% CI 0.51-0.89, P < 0.01), and hypertension (OR 0.66, 95% CI 0.52-0.82, P < 0.01). However, tolvaptan was associated with a higher incidence rate of adverse events such as thirst (OR 8.48 95% CI 4.53-15.87, P < 0.01), polyuria (OR 4.71, 95% CI 2.17-10.24, P < 0.01), and hepatic injury (OR 4.56, 95% CI 2.51-8.29, P < 0.01).
Tolvaptan can delay eGFR decline and TKV increase and reduce complications such as renal pain, urinary tract infection, haematuria, and hypertension in the treatment of ADPKD. However, tolvaptan increases the adverse effects of thirst, polyuria and hepatic injury.
本荟萃分析旨在比较托伐普坦与安慰剂治疗常染色体显性多囊肾病（ADPKD）的疗效和药物安全性。
检索PubMed、Embase 和 Cochrane Library 数据库，检索时间截至 2021 年 9 月 10 日。纳入比较托伐普坦与安慰剂治疗 ADPKD 患者的研究。采用 Review Manager Version 5.3 进行数据分析。
荟萃分析纳入了 13 项研究，共 3575 例患者。与安慰剂相比，托伐普坦在延缓 ADPKD 患者 eGFR 下降（MD 1.27，95%CI 1.24-1.29，P<0.01）和 TKV 增加（MD -3.01，95%CI -3.55 至-2.47，P<0.01）方面效果更好。此外，托伐普坦降低了肾痛（OR 0.71，95%CI 0.58-0.87，P<0.01）、尿路感染（OR 0.69，95%CI 0.54-0.89，P<0.01）、血尿（OR 0.68，95%CI 0.51-0.89，P<0.01）和高血压（OR 0.66，95%CI 0.52-0.82，P<0.01）等并发症的发生率。然而，托伐普坦与不良反应的发生率较高有关，如口渴（OR 8.48，95%CI 4.53-15.87，P<0.01）、多尿（OR 4.71，95%CI 2.17-10.24，P<0.01）和肝损伤（OR 4.56，95%CI 2.51-8.29，P<0.01）。
托伐普坦可延缓 eGFR 下降和 TKV 增加，并降低肾痛、尿路感染、血尿和高血压等并发症的发生率。然而，托伐普坦会增加口渴、多尿和肝损伤等不良反应的发生风险。
