SCHARR, The University of Sheffield, Sheffield, Yorkshire, UK
SCHARR, The University of Sheffield, Sheffield, Yorkshire, UK.
RMD Open. 2024 Jan 10;10(1):e003588. doi: 10.1136/rmdopen-2023-003588.
Immune-suppressing drugs can cause liver, kidney or blood toxicity. Prognostic factors for these adverse-events are poorly understood.
To ascertain prognostic factors associated with liver, blood or kidney adverse-events in people receiving immune-suppressing drugs.
MEDLINE, Web of Science, EMBASE and the Cochrane library (01 January 1995 to 05 January 2023), and supplementary sources.
Data were extracted by one reviewer using a modified CHARMS-PF checklist and validated by another. Two independent reviewers assessed risk of bias using Quality in Prognostic factor Studies tool and assessed the quality of evidence using a Grading of Recommendations Assessment, Development and Evaluation-informed framework.
Fifty-six studies from 58 papers were included. High-quality evidence of the following associations was identified: elevated liver enzymes (6 studies) and folate non-supplementation (3 studies) are prognostic factors for hepatotoxicity in those treated with methotrexate; that mercaptopurine (vs azathioprine) (3 studies) was a prognostic factor for hepatotoxicity in those treated with thiopurines; that mercaptopurine (vs azathioprine) (3 studies) and poor-metaboliser status (4 studies) were prognostic factors for cytopenia in those treated with thiopurines; and that baseline elevated liver enzymes (3 studies) are a prognostic factor for hepatotoxicity in those treated with anti-tumour necrosis factors. Moderate and low quality evidence for several other demographic, lifestyle, comorbidities, baseline bloods/serologic or treatment-related prognostic factors were also identified.
Studies published before 1995, those with less than 200 participants and not published in English were excluded. Heterogeneity between studies included different cut-offs for prognostic factors, use of different outcome definitions and different adjustment factors.
Prognostic factors for target-organ damage were identified which may be further investigated for their potential role in targeted (risk-stratified) monitoring.
CRD42020208049.
免疫抑制药物会导致肝、肾或血液毒性。这些不良事件的预后因素了解甚少。
确定接受免疫抑制药物治疗的患者发生肝、血液或肾脏不良事件的相关预后因素。
MEDLINE、Web of Science、EMBASE 和 Cochrane 图书馆（1995 年 1 月 1 日至 2023 年 1 月 5 日）以及补充来源。
一位审稿人使用改良的 CHARMS-PF 清单提取数据，并由另一位审稿人进行验证。两位独立的审稿人使用预后因素研究质量工具评估偏倚风险，并使用基于推荐评估、制定和评估的分级框架评估证据质量。
纳入了 58 篇论文中的 56 项研究。确定了以下关联的高质量证据：接受甲氨蝶呤治疗的患者中，肝酶升高（6 项研究）和叶酸未补充（3 项研究）是肝毒性的预后因素；硫唑嘌呤治疗组中，巯嘌呤（与硫唑嘌呤相比）（3 项研究）是肝毒性的预后因素；硫唑嘌呤治疗组中，巯嘌呤（与硫唑嘌呤相比）（3 项研究）和代谢不良状态（4 项研究）是细胞减少症的预后因素；以及抗肿瘤坏死因子治疗组中，基线时肝酶升高（3 项研究）是肝毒性的预后因素。还确定了其他几个与人口统计学、生活方式、合并症、基线血液/血清学或治疗相关的预后因素的中度和低质量证据。
排除了 1995 年以前发表的研究、少于 200 名参与者的研究以及未以英文发表的研究。纳入的研究之间存在异质性，包括预后因素的不同截止值、不同的结局定义和不同的调整因素。
确定了靶器官损伤的预后因素，这些因素可能会进一步研究其在靶向（风险分层）监测中的潜在作用。
PROSPERO 注册号：CRD42020208049。
