哮喘联盟

   摘要
   目的：旨在研究现有维持治疗，包括吸入性糖皮质激素（ICS），长效β受体激动剂（LABA）和/或白三烯受体拮抗剂(LTRAs) 在儿童哮喘中防止病情恶化、改善症状中的作用。
   方法：通过广泛搜索PubMed, Cochrane图书馆, Embase 和 临床试验数据库，获取相关研究，运用网络荟萃分析进行系统性回顾。文献搜索截止为2014年7月。随机临床试验被纳入研究，与全球哮喘防治倡议指南的治疗策略相比较。能够获取全文的随机临床试验纳入研究，研究针对儿童（18岁以下）哮喘患者，试验持续4周及以上，并报导疾病恶化或无症状天数。主要和次要有效性终点分别为中/重度哮喘恶化发生率及从基线起的无症状天数。退出率被作为安全性终点。
   结果：网络荟萃分析纳入35项试验，共计12010名受试者。针对主要和次要终点，合并使用ICS和LABA有效性位列第一（OR和CI分别为：OR 0.70, 95% CI: 0.52-0.97，OR 1.23, 95% CI: 0.94-1.61，与低剂量ICS相比），但次要终点的结果具有统计学差异。低剂量ICS,中等或高剂量ICS以及联合使用ICS和LABA都进行有效性比较。ICS单一疗法、ICS联合LABA以及ICS联合LTRA安全性相似。高剂量ICS总退出率最高，但与其他组相较无统计学额差异。
   结论：ICS联合LABA治疗在儿童哮喘患者中防止病情恶化最有效。中等或高剂量ICS，ICS联合LTRA以及低剂量ICS治疗有效性相同。
 

（杨冬 审校）
 J Asthma. 2015 Jun 10:1-12. [Epub ahead of print]
 

Effectiveness of drug treatment strategies to prevent asthma exacerbations and increase symptom-free days in asthmatic children: a network meta-analysis.
 

Zhao Y1, Han S, Shang J, Zhao X, Pu R, Shi L.
 

Abstract
OBJECTIVE:To determine the effectiveness and safety of current maintenance therapies that include inhaled corticosteroids (ICS), long-acting β-agonists (LABA) and/or leukotriene receptor antagonists (LTRAs) in preventing exacerbations and improving symptoms in pediatric asthma.
METHODS:A systematic review with network meta-analysis was conducted after a comprehensive search for relevant studies in the PubMed, Cochrane Library, Embase and Clinical Trials databases, up to July 2014. Randomized clinical trials were selected comparing treatment strategies of the Global Initiative for Asthmaguidelines. The full-text randomized clinical trials compared maintenance treatments for asthma in children (≤18 years) of ≥4 weeks duration, reporting exacerbations or symptom-free days. The primary and secondary effectiveness outcomes were the rates of moderate/severe exacerbations and symptom-free days from baseline, respectively. Withdrawal rates were taken as the safety outcome.
RESULTS:Included in the network meta-analysis was 35 trials, comprising 12 010 patients. For both primary and secondary outcomes, combined ICS and LABA was ranked first in effectiveness (OR 0.70, 95% CI: 0.52-0.97 and OR 1.23, 95% CI: 0.94-1.61, respectively, compared with low-dose ICS), but the result of secondary outcomes was statistically insignificant. Low-dose ICS, medium- or high-dose ICS and combined ICS and LTRA strategies were comparable in effectiveness. ICS monotherapies, and ICS + LABA and ICS + LTRA strategies were similarly safe. High-dose ICS had the highest rate of total withdrawals, but the difference was not significant.
CONCLUSIONS:Combined ICS and LABA treatments were most effective in preventing exacerbations among pediatric asthma patients. Medium- or high-dose ICS, combined ICS and LTRAs, and low-dose ICS treatments seem to be equally effective.
 

J Asthma. 2015 Jun 10:1-12. [Epub ahead of print]