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生物制剂、多靶点治疗和狼疮肾炎标准治疗的疗效和安全性：系统评价和网络荟萃分析。

Efficacy and safety of biologics, multitarget therapy, and standard therapy for lupus nephritis: a systematic review and network meta-analysis.

机构信息

Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Ren Fail. 2024 Dec;46(2):2395451. doi: 10.1080/0886022X.2024.2395451. Epub 2024 Aug 30.

DOI:10.1080/0886022X.2024.2395451
PMID:39212247
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11370699/
Abstract

OBJECTIVE

This study aimed to compare the efficacy and safety of biologics, multitarget therapy, and standard therapy for the induction of lupus nephritis.

METHODS

A systematic search of electronic databases (EMBASE, Web of Science, PubMed, Cochrane Library, and ClinicalTrials.gov) was conducted from inception to 30 August 2023. Our study included randomized controlled trials enrolling adult lupus nephritis patients treated with biologics or multitarget therapy, in comparison with standard therapy. The primary outcomes were the rates of complete renal remission (CRR) and serious adverse events (SAE). Stata 15.0 was used to conduct the network meta-analysis.

RESULTS

Ten randomized controlled trials with a total of 1989 patients met the inclusion criteria. The network meta-analysis indicated that compared with standard therapy, multitarget therapy, obinutuzumab, belimumab, and voclosporin therapy demonstrated superior efficacy in achieving complete renal remission. Among these options, multitarget therapy had the greatest effect (OR = 2.78, 95% CI = 1.81-4.26). Regarding safety, it was observed that there were no significant statistical differences among the various treatment options. Cluster analysis revealed that both obinutuzumab and belimumab exhibited good efficacy and safety.

CONCLUSIONS

belimumab and obinutuzumab stood out as promising treatments due to their good performance in terms of efficacy and safety. Multitarget therapy may be the most effective approach for treating lupus nephritis. However, since the study population consists exclusively of Asian patients, further research is needed to verify the efficacy of multitarget therapy in lupus nephritis patients of non-Asian descent.

摘要

目的

本研究旨在比较生物制剂、多靶点治疗与标准治疗在诱导狼疮肾炎中的疗效和安全性。

方法

系统检索电子数据库（EMBASE、Web of Science、PubMed、Cochrane Library 和 ClinicalTrials.gov），检索时间从建库至 2023 年 8 月 30 日。本研究纳入了比较生物制剂或多靶点治疗与标准治疗的成人狼疮肾炎患者的随机对照试验。主要结局指标为完全肾脏缓解（CRR）率和严重不良事件（SAE）发生率。采用 Stata 15.0 进行网络荟萃分析。

结果

纳入了 10 项随机对照试验，共计 1989 例患者符合纳入标准。网络荟萃分析表明，与标准治疗相比，多靶点治疗、奥滨尤妥珠单抗、贝利尤单抗和 voclosporin 治疗在实现完全肾脏缓解方面具有更好的疗效。在这些选择中，多靶点治疗的效果最大（OR=2.78，95%CI=1.81-4.26）。关于安全性，观察到各种治疗方案之间没有显著的统计学差异。聚类分析显示，奥滨尤妥珠单抗和贝利尤单抗均表现出良好的疗效和安全性。

结论

贝利尤单抗和奥滨尤妥珠单抗因疗效和安全性良好而脱颖而出。多靶点治疗可能是治疗狼疮肾炎最有效的方法。然而，由于研究人群仅包括亚洲患者，因此需要进一步研究来验证多靶点治疗在非亚洲裔狼疮肾炎患者中的疗效。

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