■目前,进展性多发性硬化症(PMS)的疾病改善疗法(DMT)在临床实践中被广泛使用。同时,DMT有多种药物选择,但是能够更好地缓解症状和改善预后的药物的效果仍然没有定论。
■本系统综述旨在评估DMT用于PMS的疗效和安全性,并确定这些药物中的最佳药物。
■MEDLINE,EMBASE,Cochrane图书馆,和临床试验进行了系统搜索,以确定1月30日之前发表的相关研究,2023年。我们使用网络荟萃分析(CINeMA)框架中的置信度评估证据的确定性。我们估计了二分结果的汇总风险比(RR)和具有95%可信间隔(CrIs)的连续结果的平均差异(MD)。
■我们纳入了18项随机对照试验(RCT),涉及9,234名患者。DMT能有效控制MS的病情进展。其中,米托蒽醌,西波莫德,和奥利珠单抗在延缓疾病进展方面优于其他药物选择(高确定性).米托蒽醌是缓解恶化(残疾进展)的最佳药物(确定性很高)。Ocrelizumab在治疗前和治疗后25英尺步行测试(T25FW;低确定性)中表现最好,所有其他代理商也是如此(RR范围:1.12-1.05)。在9孔钉试验(9HPT)中,那他珠单抗表现最好(高确定性),所有其他代理商也是如此(RR范围:1.59-1.09)。在成像方面,IFN-β-1b在新的T2低信号病变上表现更好,治疗前后(高确定性),虽然西波莫德在治疗前后的T2加权图像对比度上表现最佳,sWASO曲线下面积(SUCRA)值最高(100%)。在不良事件(AE)方面,利妥昔单抗(RR1.01),拉喹莫德(RR1.02)比安慰剂更有效(高确定性)。就严重不良事件(SAE)而言,那他珠单抗(RR1.09),和奥利珠单抗(RR1.07)比安慰剂更安全(高确定性).
■DMTs可以在PMS治疗过程中有效控制疾病进展并减少疾病恶化。
■https://inplasy.com/?s=202320071,标识符:202320071。
UNASSIGNED: Currently, disease-modifying therapies (DMTs) for progressive multiple sclerosis (PMS) are widely used in clinical practice. At the same time, there are a variety of drug options for DMTs, but the effect of the drugs that can better relieve symptoms and improve the prognosis are still inconclusive.
UNASSIGNED: This systematic review aimed to evaluate the efficacy and safety of DMTs for PMS and to identify the best among these drugs.
UNASSIGNED: MEDLINE, EMBASE, the Cochrane Library, and clinicaltrials.gov were systematically searched to identify relevant studies published before 30 January, 2023. We assessed the certainty of the evidence using the confidence in the network meta-analysis (CINeMA) framework. We estimated the summary risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes with 95% credible intervals (CrIs).
UNASSIGNED: We included 18 randomized controlled trials (RCTs) involving 9,234 patients in the study. DMT can effectively control the disease progression of MS. Among them, mitoxantrone, siponimod, and ocrelizumab are superior to other drug options in delaying disease progression (high certainty). Mitoxantrone was the best (with high certainty) for mitigating deterioration (progression of disability). Ocrelizumab performed best on the pre- and post-treatment Timed 25-Foot Walk test (T25FW; low certainty), as did all other agents (RR range: 1.12-1.05). In the 9-Hole Peg Test (9HPT),
natalizumab performed the best (high certainty), as did all other agents (RR range: 1.59-1.09). In terms of imaging, IFN-beta-1b performed better on the new T2 hypointense lesion on contrast, before and after treatment (high certainty), while siponimod performed best on the change from baseline in the total volume of lesions on T2-weighted image contrast before and after treatment (high certainty), and sWASO had the highest area under the curve (SUCRA) value (100%). In terms of adverse events (AEs), rituximab (RR 1.01), and laquinimod (RR 1.02) were more effective than the placebo (high certainty). In terms of serious adverse events (SAEs),
natalizumab (RR 1.09), and ocrelizumab (RR 1.07) were safer than placebo (high certainty).
UNASSIGNED: DMTs can effectively control disease progression and reduce disease deterioration during the treatment of PMS.
UNASSIGNED: https://inplasy.com/?s=202320071, identifier: 202320071.