Xiong Yu, Hu Jia-Qiang, Tang Hui-Lin, Zhao Zhi-Xia, Liu Li-Hong
Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China.
Front Med (Lausanne). 2024 Feb 13;11:1334442. doi: 10.3389/fmed.2024.1334442. eCollection 2024.
Monoclonal antibodies (mAbs) against cytokines and chemokines or their receptors promise to be a potential therapeutic option to address chronic obstructive pulmonary disease (COPD). We aim to provide a comprehensive literature review of the improvement in FEV1 and safety when comparing mAbs with conventional dichotomous agents.
We systematically searched 3 electronic databases (PubMed, EMBASE, and CENTRAL) up to August 1, 2023 to collect eligible randomized controlled trials (RCTs). A frequentist network meta-analysis using a random-effects model was deployed to calculate mean differences (MD) for FEV1, relative risk (RR) of treatment-emergent adverse events (TEAEs), and estimate the surface under cumulative rankings (SUCRA). A higher SUCRA indicates a better outcome.
This study included 23 RCTs involving a total of 20,853 patients. Overall, except for Dupilumab, mAbs did not significantly improve FEV1 compared to traditional conventional dichotomous agents. Among all the interventions included, Aclidinium bromide/Formoterol (AB/FF) (SUCRA 97.7%) ranked highest, followed by Umeclidinium/vilanterol (UMEC/VI) (SUCRA 93.5%), and Glycopyrrolate Formoterol Fumarate (GFF) (SUCRA 84.7%). Dupilumab (SUCRA 66.9%) ranked the fourth among all interventions but ranked the first among all the mAbs. Importantly, all mAbs demonstrated a good safety profile compared with placebo.
Considering the improvement in FEV1 and its safety, the development of mAbs for COPD still holds significant clinical potential.
PROSPERO, CRD42023452714.
针对细胞因子、趋化因子及其受体的单克隆抗体（mAb）有望成为治疗慢性阻塞性肺疾病（COPD）的一种潜在选择。我们旨在全面综述单克隆抗体与传统二分法药物相比，在改善第1秒用力呼气容积（FEV1）和安全性方面的相关文献。
我们系统检索了截至2023年8月1日的3个电子数据库（PubMed、EMBASE和CENTRAL），以收集符合条件的随机对照试验（RCT）。采用随机效应模型进行频率论网络荟萃分析，计算FEV1的平均差（MD）、治疗中出现的不良事件（TEAE）的相对风险（RR），并估计累积排名曲线下面积（SUCRA）。SUCRA值越高表明结果越好。
本研究纳入23项RCT，共涉及20,853例患者。总体而言，除度普利尤单抗外，与传统二分法药物相比，单克隆抗体并未显著改善FEV1。在所有纳入的干预措施中，溴化阿地氯铵/福莫特罗（AB/FF）（SUCRA 97.7%）排名最高，其次是乌美溴铵/维兰特罗（UMEC/VI）（SUCRA 93.5%）和格隆溴铵富马酸福莫特罗（GFF）（SUCRA 84.7%）。度普利尤单抗（SUCRA 66.9%）在所有干预措施中排名第四，但在所有单克隆抗体中排名第一。重要的是，与安慰剂相比，所有单克隆抗体均显示出良好的安全性。
考虑到FEV1的改善及其安全性，用于COPD的单克隆抗体的研发仍具有显著的临床潜力。
PROSPERO，CRD42023452714。
