tezepelumab与mepolizumab,benralizumab和dupilumab治疗嗜酸性哮喘的疗效比较:贝
2023/03/21
tezepelumab与mepolizumab,benralizumab和dupilumab治疗嗜酸性哮喘的疗效比较:贝叶斯网络荟萃分析
摘要
背景：目前尚不清楚被批准用于治疗2型高、低哮喘的tezepelumab与其他生物制剂治疗2型高哮喘相比疗效如何。
目的：我们试图对tezepelumab与dupilumab、benralizumab和mepolizumab治疗嗜酸细胞性哮喘进行间接比较。
方法；研究人员进行了系统回顾和贝叶斯网络元分析。他们确定了2000年1月1日至2022年8月12日期间在PubMed、Embase或Cochrane中央对照试验登记册(Central)中索引的随机对照试验。结果包括加重率、支气管扩张剂前FEV1和哮喘控制问卷。
结果：10个随机对照试验(n=9201)符合条件。尽管95%CI越过了0的空值，Tezepelumab(相对风险:0.63;95%可信区间[CI]:0.46-0.86)与benralizumab相比有显著降低的加重率，与mepolizumab和benralizumab相比有更大的FEV1改善(mepolizumab[MD]:66;95%CI:-33至170);benralizumab (MD: 62;95% CI: -22到150)。Mepolizumab对哮喘控制问卷评分的改善最大，但这种改善与tezepelumab没有显著差异(tezepelumab vs Mepolizumab;MD: 0.14;95% CI: -0.10至0.38)。对于临床重要阈值的疗效，与安慰剂相比，tezepelumab、mepolizumab和dupilumab降低急性加重率≥50%的概率为99%，而benralizumab只有66%的概率。Tezepelumab和dupilumab提高支气管扩张剂前FEV1≥100mL的概率为1.00。与mepolizumab相比，dupilumab有90%的机会将FEV1提高≥50mL，但生物制剂之间的差异均不超过100mL。
结论：在嗜酸性粒细胞性哮喘患者中，tezepelumab和dupilumab在加重率和肺功能方面比benralizumab或mepolizumab有更大的改善(尽管低于临床阈值)。
Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis
Tanawin Nopsopon, Grace Lassiter, Ming-Li Chen, G Caleb Alexander, Corinne Keet, Hwanhee Hong, Ayobami Akenroye
Abstract
BACKGRUND:It is unclear how the efficacy of tezepelumab, approved for the treatment of type 2 high and low asthma, compares to the efficacy of other biologics for type 2-high asthma.
OBJECTIVES: We sought to conduct an indirect comparison of tezepelumab to dupilumab, benralizumab, and mepolizumab in the treatment of eosinophilic asthma.
METHODS: The investigators conducted a systematic review and Bayesian network meta-analyses. They identified randomized controlled trials indexed in PubMed, Embase, or Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 2000, and August 12, 2022. Outcomes included exacerbation rates, prebronchodilator FEV1, and the Asthma Control Questionnaire.
RESULTS: Ten randomized controlled trials (n= 9201) met eligibility. Tezepelumab (relative risk: 0.63; 95% credible interval [CI]: 0.46-0.86) was associated with significantly lower exacerbation rates than benralizumab and larger improvements in FEV1 compared to mepolizumab (mean difference [MD]: 66; 95% CI: -33 to 170) and benralizumab (MD: 62; 95% CI: -22 to 150), though the 95% CI crossed the null value of 0. Mepolizumab improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of tezepelumab (tezepelumab vs mepolizumab; MD: 0.14; 95% CI: -0.10 to 0.38). For efficacy by clinically important thresholds, tezepelumab, mepolizumab, and dupilumab achieved a >99% probability of reducing exacerbation rates by ≥50% compared to placebo, but benralizumab had only a 66% probability of doing so. Tezepelumab and dupilumab had a probability of 1.00 of improving prebronchodilator FEV1 by ≥100 mL above placebo. Compared to mepolizumab, dupilumab had >90% chance for improving FEV1 by ≥50 mL, but none of the differences between biologics exceeded 100 mL.
CONCLUSIONS: In individuals with eosinophilic asthma, tezepelumab and dupilumab were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than benralizumab or mepolizumab.
摘要
背景：目前尚不清楚被批准用于治疗2型高、低哮喘的tezepelumab与其他生物制剂治疗2型高哮喘相比疗效如何。
目的：我们试图对tezepelumab与dupilumab、benralizumab和mepolizumab治疗嗜酸细胞性哮喘进行间接比较。
方法；研究人员进行了系统回顾和贝叶斯网络元分析。他们确定了2000年1月1日至2022年8月12日期间在PubMed、Embase或Cochrane中央对照试验登记册(Central)中索引的随机对照试验。结果包括加重率、支气管扩张剂前FEV1和哮喘控制问卷。
结果：10个随机对照试验(n=9201)符合条件。尽管95%CI越过了0的空值，Tezepelumab(相对风险:0.63;95%可信区间[CI]:0.46-0.86)与benralizumab相比有显著降低的加重率，与mepolizumab和benralizumab相比有更大的FEV1改善(mepolizumab[MD]:66;95%CI:-33至170);benralizumab (MD: 62;95% CI: -22到150)。Mepolizumab对哮喘控制问卷评分的改善最大，但这种改善与tezepelumab没有显著差异(tezepelumab vs Mepolizumab;MD: 0.14;95% CI: -0.10至0.38)。对于临床重要阈值的疗效，与安慰剂相比，tezepelumab、mepolizumab和dupilumab降低急性加重率≥50%的概率为99%，而benralizumab只有66%的概率。Tezepelumab和dupilumab提高支气管扩张剂前FEV1≥100mL的概率为1.00。与mepolizumab相比，dupilumab有90%的机会将FEV1提高≥50mL，但生物制剂之间的差异均不超过100mL。
结论：在嗜酸性粒细胞性哮喘患者中，tezepelumab和dupilumab在加重率和肺功能方面比benralizumab或mepolizumab有更大的改善(尽管低于临床阈值)。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（J Allergy Clin Immunol. 2023 Mar;151(3):747-755. DOI: 10.1016/j.jaci.2022.11.021）
（J Allergy Clin Immunol. 2023 Mar;151(3):747-755. DOI: 10.1016/j.jaci.2022.11.021）
Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis
Tanawin Nopsopon, Grace Lassiter, Ming-Li Chen, G Caleb Alexander, Corinne Keet, Hwanhee Hong, Ayobami Akenroye
Abstract
BACKGRUND:It is unclear how the efficacy of tezepelumab, approved for the treatment of type 2 high and low asthma, compares to the efficacy of other biologics for type 2-high asthma.
OBJECTIVES: We sought to conduct an indirect comparison of tezepelumab to dupilumab, benralizumab, and mepolizumab in the treatment of eosinophilic asthma.
METHODS: The investigators conducted a systematic review and Bayesian network meta-analyses. They identified randomized controlled trials indexed in PubMed, Embase, or Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 2000, and August 12, 2022. Outcomes included exacerbation rates, prebronchodilator FEV1, and the Asthma Control Questionnaire.
RESULTS: Ten randomized controlled trials (n= 9201) met eligibility. Tezepelumab (relative risk: 0.63; 95% credible interval [CI]: 0.46-0.86) was associated with significantly lower exacerbation rates than benralizumab and larger improvements in FEV1 compared to mepolizumab (mean difference [MD]: 66; 95% CI: -33 to 170) and benralizumab (MD: 62; 95% CI: -22 to 150), though the 95% CI crossed the null value of 0. Mepolizumab improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of tezepelumab (tezepelumab vs mepolizumab; MD: 0.14; 95% CI: -0.10 to 0.38). For efficacy by clinically important thresholds, tezepelumab, mepolizumab, and dupilumab achieved a >99% probability of reducing exacerbation rates by ≥50% compared to placebo, but benralizumab had only a 66% probability of doing so. Tezepelumab and dupilumab had a probability of 1.00 of improving prebronchodilator FEV1 by ≥100 mL above placebo. Compared to mepolizumab, dupilumab had >90% chance for improving FEV1 by ≥50 mL, but none of the differences between biologics exceeded 100 mL.
CONCLUSIONS: In individuals with eosinophilic asthma, tezepelumab and dupilumab were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than benralizumab or mepolizumab.
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