The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China.
Xiangya School of Nursing, Central South University, Changsha, Hunan Province, 410013, China.
Curr Neuropharmacol. 2023;21(8):1827-1834. doi: 10.2174/1570159X20666220922151442.
This study aims to provide an overview of meta-analyses and systematic reviews on the effectiveness and safety of immunosuppressive drug therapy for neuromyelitis optica spectrum disorders (NMOSD) by evaluating the methodological quality and reporting quality of reviews.
The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database, Web of Science, the Cochrane Library, PubMed, and Embase databases were searched to collect systematic reviews or meta-analyses on the effectiveness and safety of immunosuppressive therapy for NMOSD from inception to December 2, 2021. Two researchers independently screened reviews and extracted data. Any differences in the procession of review assessment between the two researchers were re-evaluated, and the disagreement was resolved by discussion with other researchers. The following data were extracted: author, year of publication, the country where the study was conducted, study type, the number of included studies, sample size, risk bias tools, medication of immunosuppressive therapy, and main outcomes. Then, the AMSTAR-2, which is a critical appraisal tool for systematic reviews (2 edition), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were used to evaluate the methodological quality and reporting quality of evidence. A comprehensive analysis was conducted on the outcomes for all included reviews.
A total of 15 reviews were included. Of the included reviews, 3 were systematic reviews, 7 were meta-analyses, and 5 were systematic reviews and meta-analyses. According to the AMSTAR-2 criteria, 6 studies had high quality, 1 study had moderate quality, 4 studies had low quality, and 4 studies had critically low quality. Based on the GRADE, neither evidence quality for effectiveness nor safety was high.
Immunosuppressive drug therapy is effective for patients with NMOSD, but its safety is controversial. Due to the poor quality of evidence, reliability needs to be considered. Thus, large sample, multi-center, double-blind, randomized controlled studies are still needed in the future.
通过评估综述的方法学质量和报告质量，为视神经脊髓炎谱系疾病（NMOSD）的免疫抑制药物治疗的有效性和安全性的荟萃分析和系统评价提供概述。
检索中国知网（CNKI）、万方数据、中国科技期刊数据库、Web of Science、Cochrane 图书馆、PubMed 和 Embase 数据库，收集截至 2021 年 12 月 2 日关于 NMOSD 免疫抑制治疗有效性和安全性的系统评价或荟萃分析。两位研究人员独立筛选评价并提取数据。若两位研究人员对评价过程存在分歧，则重新评估，通过与其他研究人员讨论解决分歧。提取的信息包括：作者、发表年份、研究开展国家、研究类型、纳入研究数量、样本量、风险偏倚工具、免疫抑制治疗药物以及主要结局。然后，使用 AMSTAR-2（系统评价的关键性评估工具（第 2 版））和推荐、评估、制定与评价分级（GRADE）评估证据的方法学质量和报告质量。对所有纳入评价的结果进行综合分析。
共纳入 15 篇评价。纳入的评价中，有 3 篇为系统评价，7 篇为荟萃分析，5 篇为系统评价和荟萃分析。根据 AMSTAR-2 标准，6 项研究质量为高，1 项为中，4 项为低，4 项为极低。基于 GRADE，有效性和安全性证据的质量均不高。
免疫抑制药物治疗对 NMOSD 患者有效，但安全性存在争议。由于证据质量较差，需要考虑可靠性。因此，未来仍需要开展大样本、多中心、双盲、随机对照研究。
