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Induction and maintenance of remission with mycophenolate mofetil in ANCA-associated vasculitis: a systematic review and meta-analysis
A. Berti, M. Alsawas, T. Jawaid, LJ. Prokop, JM. Lee, GH. Jeong, LF. Quintana, S. Moiseev, A. Vaglio, V. Tesar, D. Geetha, JIL. Shin, A. Kronbichler
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu metaanalýza, systematický přehled, časopisecké články
NLK
Free Medical Journals
od 1996 do Před 1 rokem
Open Access Digital Library
od 1996-01-01
PubMed
34910216
DOI
10.1093/ndt/gfab357
Knihovny.cz E-zdroje
- MeSH
- ANCA-asociované vaskulitidy * farmakoterapie MeSH
- imunosupresiva terapeutické užití MeSH
- indukce remise MeSH
- kyselina mykofenolová terapeutické užití MeSH
- lidé MeSH
- mikroskopická polyangiitida * MeSH
- peroxidasa MeSH
- protilátky proti cytoplazmě neutrofilů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
BACKGROUND: Uncertainties exist about the use of mycophenolate mofetil (MMF) in anti-neutrophil cytoplasmatic antibody (ANCA)-associated vasculitis (AAV), particularly for remission maintenance. METHODS: Systematic review and meta-analysis of phase II and III trials assessing the use of MMF in AAV, granulomatosis with polyangiitis and microscopic polyangiitis (MPA). A comprehensive search of several databases (Medline, EMBASE, Cochrane, Web of Science, Scopus) from inception to 5 May 2020 has been conducted. Trial data were extracted to estimate odds ratios (ORs) and estimates (ES) for MMF efficacy (remission-induction and maintenance). Severe adverse effects (SAEs) were collected. RESULTS: From 565 articles captured, 10 met the predefined criteria, 5 phase II and 5 III trials; 4 assessed remission-induction, 3 remission maintenance and 3 both. The pooled OR for remission-induction at 6 months was 1.06 (95% confidence interval 0.74, 1.52), with no significant difference by subgroup meta-analysis of trials stratified by different study-level features (i.e. kidney disease, MPA, myeloperoxidase-ANCA positivity, newly diagnosed disease) (P > 0.05). The overall ES for remission maintenance at the end of follow-up ranged between 51% and 91% (I2 = 74.8%). Subgroup meta-analysis identified kidney involvement as a possible source of heterogeneity, yielding a significantly higher rate of sustained remission in trials enrolling only patients with kidney involvement (92%, 76-100%) versus those enrolling patients with and without kidney involvement (56%, 45-66%). Results were similar in multiple sensitivity analyses. During follow-up, the frequency of SAEs in MMF-based treatment arms was 31.8%. CONCLUSIONS: In AAV, MMF use was significantly associated with higher sustained remission rates in trials enrolling only patients with kidney involvement. These findings might influence clinical practice.
College of Medicine Gyeongsang National University Jinju Republic of Korea
Department of Medicine University of Cambridge Cambridge UK
Department of Pathology University of Iowa IA City IA USA
Department of Pediatrics Yonsei University College of Medicine Seoul Republic of Korea
Evidence Based Practice Center Mayo Clinic Rochester MN USA
Mayo Clinic Libraries Mayo Clinic Rochester MN USA
Reference Center in Complex Glomerular Disease of the National Health System Barcelona Spain
Tareev Clinic of Internal Diseases Sechenov 1st Moscow State Medical University Moscow Russia
Vasculitis and Lupus Clinic Addenbrooke's Hospital Cambridge University Hospitals Cambridge UK
Citace poskytuje Crossref.org
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