PDF(Pubmed)
Abstract：
BACKGROUND: Immune-suppressing drugs can cause liver, kidney or blood toxicity. Prognostic factors for these adverse-events are poorly understood.
OBJECTIVE: To ascertain prognostic factors associated with liver, blood or kidney adverse-events in people receiving immune-suppressing drugs.
METHODS: MEDLINE, Web of Science, EMBASE and the Cochrane library (01 January 1995 to 05 January 2023), and supplementary sources.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: Prognostic factors for target-organ damage were identified which may be further investigated for their potential role in targeted (risk-stratified) monitoring.
UNASSIGNED: CRD42020208049.
OBJECTIVE: To ascertain prognostic factors associated with liver, blood or kidney adverse-events in people receiving immune-suppressing drugs.
METHODS: MEDLINE, Web of Science, EMBASE and the Cochrane library (01 January 1995 to 05 January 2023), and supplementary sources.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: Prognostic factors for target-organ damage were identified which may be further investigated for their potential role in targeted (risk-stratified) monitoring.
UNASSIGNED: CRD42020208049.
摘要：
背景：免疫抑制药物可引起肝脏，肾或血液毒性。对这些不良事件的预后因素了解甚少。
目的：为了确定与肝脏相关的预后因素，接受免疫抑制药物的人的血液或肾脏不良事件。
方法：MEDLINE，WebofScience,EMBASE和Cochrane图书馆（1995年1月1日至2023年1月5日），补充来源。
方法：一位审阅者使用修改后的CHARMS-PF检查表提取数据，并由另一位审阅者进行验证。两名独立审稿人使用预后因素研究工具中的质量评估偏倚风险，并使用建议评估分级评估评估证据质量。发展和评价知情框架。
结果：纳入了58篇论文的56项研究。确定了以下关联的高质量证据：肝酶升高（6项研究）和叶酸不补充（3项研究）是甲氨蝶呤治疗患者肝毒性的预后因素；巯基嘌呤（与硫唑嘌呤相比）（3项研究）是硫嘌呤治疗患者肝毒性的预后因素；巯基肿瘤坏死（与硫唑嘌呤相比）治疗的基线研究（3项研究）和低代谢因子（3项研究）其他几个人口统计的中等和低质量证据，生活方式,合并症,还确定了基线血液/血清学或治疗相关的预后因素.
结论：在1995年之前发表的研究中，参与者少于200人且未以英文发表的研究被排除在外。研究之间的异质性包括预后因素的不同截止值，使用不同的结果定义和不同的调整因子。
结论：确定了靶器官损伤的预后因素，可以进一步研究其在靶向（风险分层）监测中的潜在作用。
■CRD4202020208049。
目的：为了确定与肝脏相关的预后因素，接受免疫抑制药物的人的血液或肾脏不良事件。
方法：MEDLINE，WebofScience,EMBASE和Cochrane图书馆（1995年1月1日至2023年1月5日），补充来源。
方法：一位审阅者使用修改后的CHARMS-PF检查表提取数据，并由另一位审阅者进行验证。两名独立审稿人使用预后因素研究工具中的质量评估偏倚风险，并使用建议评估分级评估评估证据质量。发展和评价知情框架。
结果：纳入了58篇论文的56项研究。确定了以下关联的高质量证据：肝酶升高（6项研究）和叶酸不补充（3项研究）是甲氨蝶呤治疗患者肝毒性的预后因素；巯基嘌呤（与硫唑嘌呤相比）（3项研究）是硫嘌呤治疗患者肝毒性的预后因素；巯基肿瘤坏死（与硫唑嘌呤相比）治疗的基线研究（3项研究）和低代谢因子（3项研究）其他几个人口统计的中等和低质量证据，生活方式,合并症,还确定了基线血液/血清学或治疗相关的预后因素.
结论：在1995年之前发表的研究中，参与者少于200人且未以英文发表的研究被排除在外。研究之间的异质性包括预后因素的不同截止值，使用不同的结果定义和不同的调整因子。
结论：确定了靶器官损伤的预后因素，可以进一步研究其在靶向（风险分层）监测中的潜在作用。
■CRD4202020208049。
