背景:多种非甾体类抗炎药(NSAIDs)已用于治疗幼年特发性关节炎(JIA)。然而,JIA的最佳方法尚未开发。
目的:进行系统评价和网络荟萃分析,以确定最佳指导。
方法:我们搜索了PubMed的随机对照试验(RCT),EMBASE,谷歌学者,CNKI,和万方没有限制发布日期或语言为8月,2023年。任何将NSAIDs与彼此或安慰剂对JIA的有效性进行比较的RCT都包括在此网络荟萃分析中。使用累积排序曲线(SUCRA)分析下的表面对处理进行排序。P值小于0.05被鉴定为具有统计学意义。
结果:我们纳入了8项RCT(1127例患者),比较了8种不同的说明,包括美洛昔康(0.125qd和0.250qd),塞来昔布(3mg/kgbid和6mg/kgbid),吡罗昔康,萘普生(5.0mg/kg/d,7.5mg/kg/d和12.5mg/kg/d),伊诺洛芬(30-40mg/kg/d),阿司匹林(60-80mg/kg/d,75mg/kg/d,和55毫克/千克/天),托美汀(15mg/kg/d),罗非考昔,和安慰剂。关于ACRPedi30应答,任何两种NSAIDs之间没有显著差异。SUCRA显示塞来昔布(6mg/kgbid)排名第一(SUCRA,88.9%),罗非考昔排名第二(SUCRA,68.1%),塞来昔布(3mg/kgbid)排名第三(SUCRA,51.0%)。任何两种NSAIDs在不良事件方面均无显著差异。SUCRA显示安慰剂排名第一(SUCRA,88.2%),吡罗昔康排名第二(SUCRA,60.5%),罗非考昔(0.6mg/kgqd)排名第三(SUCRA,56.1%),美洛昔康(0.125mg/kgqd)排名第四(SUCRA,56.1%),罗非考昔(0.3mg/kgqd)排名第五(SUCRA,56.1%)。
结论:总之,塞来昔布(6mg/kgbid)是治疗JIA最有效的NSAID。罗非考昔,吡罗昔康,美洛昔康可能是更安全的选择,但需要进一步的研究来在更大的试验和更高质量的研究中证实这些发现.
BACKGROUND: Various non-steroidal anti-inflammatory drugs (NSAIDs) have been used for juvenile idiopathic arthritis (JIA). However, the optimal method for JIA has not yet been developed.
OBJECTIVE: To perform a systematic review and network meta-analysis to determine the optimal instructions.
METHODS: We searched for randomized controlled trials (RCTs) from PubMed, EMBASE, Google Scholar, CNKI, and Wanfang without restriction for publication date or language at August, 2023. Any RCTs that comparing the effectiveness of NSAIDs with each other or placebo for JIA were included in this network meta-analysis. The surface under the cumulative ranking curve (SUCRA) analysis was used to rank the treatments. P value less than 0.05 was identified as statistically significant.
RESULTS: We included 8 RCTs (1127 patients) comparing 8 different instructions including meloxicam (0.125 qd and 0.250 qd), Celecoxib (3 mg/kg bid and 6 mg/kg bid), piroxicam, Naproxen (5.0 mg/kg/d, 7.5 mg/kg/d and 12.5 mg/kg/d), inuprofen (30-40 mg/kg/d), Aspirin (60-80 mg/kg/d, 75 mg/kg/d, and 55 mg/kg/d), Tolmetin (15 mg/kg/d), Rofecoxib, and placebo. There were no significant differences between any two NSAIDs regarding ACR Pedi 30 response. The SUCRA shows that celecoxib (6 mg/kg bid) ranked first (SUCRA, 88.9%), rofecoxib ranked second (SUCRA, 68.1%), Celecoxib (3 mg/kg bid) ranked third (SUCRA, 51.0%). There were no significant differences between any two NSAIDs regarding adverse events. The SUCRA shows that placebo ranked first (SUCRA, 88.2%), piroxicam ranked second (SUCRA, 60.5%), rofecoxib (0.6 mg/kg qd) ranked third (SUCRA, 56.1%), meloxicam (0.125 mg/kg qd) ranked fourth (SUCRA, 56.1%), and rofecoxib (0.3 mg/kg qd) ranked fifth (SUCRA, 56.1%).
CONCLUSIONS: In summary, celecoxib (6 mg/kg bid) was found to be the most effective NSAID for treating JIA. Rofecoxib, piroxicam, and meloxicam may be safer options, but further research is needed to confirm these findings in larger trials with higher quality studies.