Abstract：
The selection of antiviral therapy for BK polyomavirus (BKPyV) infection has been extensively debated. Our study aimed to assess the efficacy and safety of various treatments for BKPyV infection.
We searched PubMed, EMBASE, and Web of Science databases for relevant studies regarding drug treatments for BKPyV viremia/DNAemia published between January 1, 1970 and September 30, 2022. Two independent authors screened the published studies, extracted pertinent data, and evaluated their methodological quality. A meta-analysis was performed using the RevMan software version 4.2.2.
A total of 33 published studies involving 986 patients were included in the meta-analysis. Overall, therapeutic interventions comprised immunosuppression reduction alone or in combination with leflunomide, intravenous immunoglobulin (IVIG), cidofovir, or mTOR inhibitor (mTORi) therapy. The meta-analysis revealed that the efficacy of immunosuppression reduction alone for serum BKPyV clearance was 68% (95% confidence interval [CI]: 0.58-0.77; I2 = 78%). Moreover, the efficacy of immunosuppression reduction in combination with leflunomide, cidofovir, IVIG, or mTORi therapy for serum BKPyV clearance was 61% (95% CI: 0.47-0.74; I2 = 83%), 71% (95% CI: 0.63-0.78; I2 = 0), 87% (95% CI: 0.82-0.93; I2 = 45%), and 80% (95% CI: 0.59-1.00; I2 = 58%), respectively. Compared to immunosuppression reduction alone, immunosuppression reduction combined with IVIG therapy offered a statistically significant benefit in serum BKPyV clearance (P < 0.01) with minimal adverse reactions, whereas other adjunctive drug treatments did not demonstrate considerable effects.
Reducing immunosuppression remains the primary approach for treating BKPyV infection. Although the combination treatment with IVIG proved to be most effective, other agents might offer varied antiviral advantages of high heterogeneity, which should be substantiated in future long-term randomized controlled trials.
We searched PubMed, EMBASE, and Web of Science databases for relevant studies regarding drug treatments for BKPyV viremia/DNAemia published between January 1, 1970 and September 30, 2022. Two independent authors screened the published studies, extracted pertinent data, and evaluated their methodological quality. A meta-analysis was performed using the RevMan software version 4.2.2.
A total of 33 published studies involving 986 patients were included in the meta-analysis. Overall, therapeutic interventions comprised immunosuppression reduction alone or in combination with leflunomide, intravenous immunoglobulin (IVIG), cidofovir, or mTOR inhibitor (mTORi) therapy. The meta-analysis revealed that the efficacy of immunosuppression reduction alone for serum BKPyV clearance was 68% (95% confidence interval [CI]: 0.58-0.77; I2 = 78%). Moreover, the efficacy of immunosuppression reduction in combination with leflunomide, cidofovir, IVIG, or mTORi therapy for serum BKPyV clearance was 61% (95% CI: 0.47-0.74; I2 = 83%), 71% (95% CI: 0.63-0.78; I2 = 0), 87% (95% CI: 0.82-0.93; I2 = 45%), and 80% (95% CI: 0.59-1.00; I2 = 58%), respectively. Compared to immunosuppression reduction alone, immunosuppression reduction combined with IVIG therapy offered a statistically significant benefit in serum BKPyV clearance (P < 0.01) with minimal adverse reactions, whereas other adjunctive drug treatments did not demonstrate considerable effects.
Reducing immunosuppression remains the primary approach for treating BKPyV infection. Although the combination treatment with IVIG proved to be most effective, other agents might offer varied antiviral advantages of high heterogeneity, which should be substantiated in future long-term randomized controlled trials.
摘要：
背景：针对BK多瘤病毒（BKPyV）感染的抗病毒治疗的选择一直存在广泛争议。我们的研究旨在评估各种治疗BKPyV感染的疗效和安全性。
方法：我们搜索了PubMed，EMBASE,1970年1月1日至2022年9月30日发表的关于BKPyV病毒血症/DNA血症药物治疗相关研究的WebofScience数据库。两位独立作者筛选了已发表的研究，提取相关数据，并评价其方法学质量。使用RevMan软件4.2.2版进行荟萃分析。
结果：共有33项已发表的研究纳入meta分析，涉及986名患者。总的来说,治疗性干预措施包括单独或联合来氟米特减少免疫抑制，静脉注射免疫球蛋白（IVIG），西多福韦,或mTOR抑制剂（mTORi）治疗。荟萃分析显示，单独减少免疫抑制对血清BKPyV清除率的功效为68％（95％置信区间[CI]：0.58-0.77；I2=78％）。此外，联合来氟米特减少免疫抑制的疗效，西多福韦,IVIG,或mTORi治疗血清BKPyV清除率为61％（95％CI：0.47-0.74；I2=83％），71%（95%CI：0.63-0.78；I2=0），87%（95%CI：0.82-0.93；I2=45%），和80%（95%CI：0.59-1.00；I2=58%），分别。与单纯减少免疫抑制相比，减少免疫抑制联合IVIG治疗在血清BKPyV清除率方面具有统计学意义（P<0.01），不良反应最小，而其他辅助药物治疗未显示出相当大的效果。
结论：减少免疫抑制仍然是治疗BKPyV感染的主要方法。尽管与IVIG的联合治疗被证明是最有效的，其他药物可能提供高异质性的多种抗病毒优势，这应该在未来的长期随机对照试验中得到证实。
方法：我们搜索了PubMed，EMBASE,1970年1月1日至2022年9月30日发表的关于BKPyV病毒血症/DNA血症药物治疗相关研究的WebofScience数据库。两位独立作者筛选了已发表的研究，提取相关数据，并评价其方法学质量。使用RevMan软件4.2.2版进行荟萃分析。
结果：共有33项已发表的研究纳入meta分析，涉及986名患者。总的来说,治疗性干预措施包括单独或联合来氟米特减少免疫抑制，静脉注射免疫球蛋白（IVIG），西多福韦,或mTOR抑制剂（mTORi）治疗。荟萃分析显示，单独减少免疫抑制对血清BKPyV清除率的功效为68％（95％置信区间[CI]：0.58-0.77；I2=78％）。此外，联合来氟米特减少免疫抑制的疗效，西多福韦,IVIG,或mTORi治疗血清BKPyV清除率为61％（95％CI：0.47-0.74；I2=83％），71%（95%CI：0.63-0.78；I2=0），87%（95%CI：0.82-0.93；I2=45%），和80%（95%CI：0.59-1.00；I2=58%），分别。与单纯减少免疫抑制相比，减少免疫抑制联合IVIG治疗在血清BKPyV清除率方面具有统计学意义（P<0.01），不良反应最小，而其他辅助药物治疗未显示出相当大的效果。
结论：减少免疫抑制仍然是治疗BKPyV感染的主要方法。尽管与IVIG的联合治疗被证明是最有效的，其他药物可能提供高异质性的多种抗病毒优势，这应该在未来的长期随机对照试验中得到证实。
