Abstract：
Bronchial thermoplasty (BT) has shown favorable safety and efficacy in several randomized controlled trials (RCTs), but has not been directly compared to biological therapies.
Electronic literature searches were performed on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, to retrieve RCTs of BT or FDA-approved biologicals against controls in patients with severe asthma. Six outcomes were analyzed: Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), the number of patients experiencing ≥1 asthma exacerbation, annualized exacerbation rate ratio (AERR), oral corticosteroid dose reduction (OCDR), and morning peak expiratory flow rate (amPEF). Random-effects, Frequentist network meta-analysis (NMA) were performed, and therapies were ranked using P-scores.
Twenty-nine RCTs (15,547 patients) were included. Fewer patients treated with BT experienced ≥1 asthma exacerbation (risk ratio [RR] = 0.66, 95%CI = 0.45-0.98) compared to control. AERR of BT versus control was non-significant, but significant improvements in ACQ score (mean difference [MD] -0.41, 95%CI -0.63 to -0.20), AQLQ score (MD = 0.54, 95%CI = 0.30-0.77), amPEF and OCDR were found. No significant differences between BT and biologics were seen across indirect comparisons of all studies.
Despite the lack of head-to-head comparative trials, this NMA suggests that BT is non-inferior to biologicals in terms of quality-of-life scores, and represents a promising alternative for patients with severe asthma.
Electronic literature searches were performed on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, to retrieve RCTs of BT or FDA-approved biologicals against controls in patients with severe asthma. Six outcomes were analyzed: Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), the number of patients experiencing ≥1 asthma exacerbation, annualized exacerbation rate ratio (AERR), oral corticosteroid dose reduction (OCDR), and morning peak expiratory flow rate (amPEF). Random-effects, Frequentist network meta-analysis (NMA) were performed, and therapies were ranked using P-scores.
Twenty-nine RCTs (15,547 patients) were included. Fewer patients treated with BT experienced ≥1 asthma exacerbation (risk ratio [RR] = 0.66, 95%CI = 0.45-0.98) compared to control. AERR of BT versus control was non-significant, but significant improvements in ACQ score (mean difference [MD] -0.41, 95%CI -0.63 to -0.20), AQLQ score (MD = 0.54, 95%CI = 0.30-0.77), amPEF and OCDR were found. No significant differences between BT and biologics were seen across indirect comparisons of all studies.
Despite the lack of head-to-head comparative trials, this NMA suggests that BT is non-inferior to biologicals in terms of quality-of-life scores, and represents a promising alternative for patients with severe asthma.
摘要：
背景：支气管热成形术（BT）在几项随机对照试验（RCT）中显示出良好的安全性和有效性，但尚未与生物疗法直接比较。
方法：在PubMed上进行电子文献检索，EMBASE,和Cochrane中央控制试验登记册，在重度哮喘患者中检索BT或FDA批准的生物制剂对照的RCT。分析了六个结果：哮喘控制问卷（ACQ），哮喘生活质量问卷（AQLQ），经历≥1次哮喘加重的患者人数，年化恶化率比率(AERR)，口服皮质类固醇剂量减少（OCDR），和早晨呼气峰流速（amPEF）。随机效果,进行了频繁网络荟萃分析(NMA)，和治疗使用P评分进行排名。
结果：纳入29个RCTs（15,547例患者）。与对照组相比，接受BT治疗的患者出现≥1次哮喘加重（风险比[RR]=0.66，95CI=0.45-0.98）。BT与对照的AERR无统计学意义，但ACQ评分显著改善(均差[MD]-0.41，95CI-0.63至-0.20)，AQLQ评分（MD=0.54，95CI=0.30-0.77），发现了amPEF和OCDR。在所有研究的间接比较中，BT和生物制剂之间没有显着差异。
结论：尽管缺乏头对头比较试验，这个NMA表明BT在生活质量评分方面不劣于生物制品，并代表了严重哮喘患者的有希望的替代方案。
方法：在PubMed上进行电子文献检索，EMBASE,和Cochrane中央控制试验登记册，在重度哮喘患者中检索BT或FDA批准的生物制剂对照的RCT。分析了六个结果：哮喘控制问卷（ACQ），哮喘生活质量问卷（AQLQ），经历≥1次哮喘加重的患者人数，年化恶化率比率(AERR)，口服皮质类固醇剂量减少（OCDR），和早晨呼气峰流速（amPEF）。随机效果,进行了频繁网络荟萃分析(NMA)，和治疗使用P评分进行排名。
结果：纳入29个RCTs（15,547例患者）。与对照组相比，接受BT治疗的患者出现≥1次哮喘加重（风险比[RR]=0.66，95CI=0.45-0.98）。BT与对照的AERR无统计学意义，但ACQ评分显著改善(均差[MD]-0.41，95CI-0.63至-0.20)，AQLQ评分（MD=0.54，95CI=0.30-0.77），发现了amPEF和OCDR。在所有研究的间接比较中，BT和生物制剂之间没有显着差异。
结论：尽管缺乏头对头比较试验，这个NMA表明BT在生活质量评分方面不劣于生物制品，并代表了严重哮喘患者的有希望的替代方案。
