白三烯抑制剂逐步替代吸入性皮质类固醇激素治疗哮喘:一项系统性综述和荟萃分析
2015/07/15
摘要
背景:使用白三烯受体抑制剂(LTRA)逐步替代吸入性皮质类固醇激素的风险并不清楚。
目的:评估停用或减量使用ICS的稳定期哮喘患者开始使用LTRA后哮喘恶化的风险。
方法:我们对多个数据库的英文和非英文文章进行了系统性的回顾,挑选出所需的文章。纳入满足以下条件的随机对照试验:哮喘稳定期4周及以上,随访时间至少3个月。纳入了满足以下条件的稳定型哮喘患者:停用ICS、而用LTRA替代的患者(与继续使用ICS治疗的患者进行比较)和使用LTRA、且ICS减量的患者(与使用安慰剂的患者进行比较)。
结果:共检索到1132篇有潜在价值的文章,对其中52篇进行了全文通读,4篇符合纳入标准。符合纳入标准的关于LTRA替代ICS治疗的一篇文章发现:LTRA替代治疗的失败率(30.3%)明显高于继续使用ICS治疗(20.2%)。符合纳入标准的关于ICS减量且使用LTRA治疗的三篇文章发现:对于>15岁的患者,LTRA治疗风险比稍有降低,为0.57 (95% 可信区间, 0.36-0.90; I(2) = 0%),倾向于支持LTRA治疗。
结论:只有一项研究指出LTRA替代ICS治疗稳定型哮喘存在风险,这限制了其他关于这一替代策略的强有力结论。
(杨冬 审校)
Allergy Asthma Proc. 2015 May;36(3):200-5. doi: 10.2500/aap.2015.36.3839.
Stepping down from inhaled corticosteroids with leukotriene inhibitors in asthma: A systematic review and meta-analysis.
Rank MA1, Gionfriddo MR, Pongdee T, Volcheck GW, Li JT, Hagan CR, Erwin PJ, Hagan JB.
Abstract
BACKGROUND:The risks of using leukotriene receptor antagonists (LTRA) as part of a strategy for stepping down inhaled corticosteroid (ICS) are not well known.
OBJECTIVE:To estimate the risk of asthma exacerbation in individuals with stable asthma who start LTRA when stopping ICS or reducing ICS dose.
METHODS:We identified articles from a systematic review of English and non-English articles by using a number of data bases. We included randomized controlled trials with a stable asthma run-in period of 4 weeks or more and a follow-up period of at least 3 months. We included studies of individuals with stable asthma who stopped ICS and substituted LTRA (versus continuing ICS) and who reduced ICS while starting LTRA (versus placebo).
RESULTS:The search strategy identified 1132 potential articles, of which 52 were reviewed at the full-text level, and four met criteria for inclusion. The single article that met the inclusion criteria for substitution of LTRA for ICS as a step-down strategy found a statistically increased risk of treatment failure of 30.3% for substituting LTRA compared with 20.2% for continuing ICS. The three articles that met the inclusion criteria for comparing LTRA versus placebo in patients with stable asthma who reduce ICS found a modestly decreased risk ratio that favored LTRA of 0.57 (95% confidence interval, 0.36-0.90; I(2) = 0%) in studies that only included individuals >15 years old.
CONCLUSION:Only one study addressed the risk of substitution of LTRA for ICS in stable asthma, which limited any strong conclusions about this step-down strategy.
Allergy Asthma Proc. 2015 May;36(3):200-5. doi: 10.2500/aap.2015.36.3839.
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对奥马珠单抗治疗儿童或青少年哮喘的系统性回顾
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吸入用布地奈德混悬液和甲强龙用于中度支气管哮喘发作治疗的比较