Network meta-analysis–based comparison of first-line steroid-sparing adjuvants in the treatment of pemphigus vulgaris and pemphigus foliaceus - 07/06/21
, Tom C. Chan, PhD e Abstract |
Background |
Steroid-sparing adjuvants may enhance oral glucocorticoid benefits in pemphigus treatment. Selecting the optimal therapeutic option among various first-line steroid-sparing adjuvants is often a clinical challenge due to the lack of head-to-head clinical trials.
Objective |
To determine the best first-line steroid-sparing adjuvants for pemphigus treatment.
Methods |
Randomized controlled trials comparing different steroid-sparing adjuvants in patients with pemphigus were identified through a systematic literature search and subjected to a network meta-analysis. The primary outcomes were the proportion of remission and the mean cumulative glucocorticoid dose.
Results |
Ten trials involving 592 patients were analyzed. Among the 7 steroid-sparing adjuvants evaluated, rituximab was the most effective for achieving remission and was more effective than steroid alone (odds ratio, 14.35; 95% confidence interval [CI], 4.71-43.68). Rituximab, azathioprine, and cyclophosphamide pulse therapy enabled the reduction of the cumulative glucocorticoid doses compared to the use of steroid alone: mean differences, −11,830.5 mg (95% CI, −14,089.48 to −9571.52), −3032.48 mg (−4700.74 to −1364.22), and −2469.54 mg (−4128.42 to −810.66), respectively.
Limitations |
The results were driven primarily by a small number of studies, and the effect estimates are imprecise because of indirect comparisons.
Conclusion |
Network meta-analysis showed that rituximab appears to be an efficacious, well tolerated steroid-sparing adjuvant for pemphigus.
Le texte complet de cet article est disponible en PDF.Key words : drug response, medical dermatology, network meta-analysis, pemphigus, steroid-sparing adjuvants
Abbreviations used : AZA, CI, CP_P, DCP_C (6M), DCP_C (12M), MMF, OR, PF, PV, RCT, SUCRA
Plan
| Funding sources: None. |
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| Conflicts of interest: None disclosed. |
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| IRB approval status: Not applicable. |
Vol 85 - N° 1
P. 176-186 - juillet 2021 Retour au numéro
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