Safety and effectiveness of mycophenolate in systemic sclerosis. A systematic review.
Safety and effectiveness of mycophenolate in systemic sclerosis. A systematic review.
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DOI：
10.1371/journal.pone.0124205
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Johnson SR
中科院分区：
文献类型：
--
作者：
Omair MA;Alahmadi A;Johnson SR
霉酚酸酯在风湿病中的应用越来越广泛。其主要不良反应是胃肠道、骨髓抑制和感染。这可能限制了系统性硬化症（SSc）的应用，因为累及胃肠道是常见的。本研究的目的是评估SSc患者服用霉酚酸酯的胃肠道不良事件。其次，我们评估了其他不良事件，以及霉酚酸酯治疗皮肤和肺部疾病的有效性。检索Medline、Embase、Cochrane Central Register of Controlled Trials和CINAHL （inception-2013）的文献。研究报告了在SSc患者中使用霉酚酸酯、不良事件、改良罗德曼皮肤评分（MRSS）、强制肺活量（FVC）或一氧化碳扩散能力（DLCO）。主要结局是开始使用霉酚酸酯后发生的胃肠道事件。次要安全性结果包括骨髓抑制、感染、恶性肿瘤和开始使用霉酚酸酯后的死亡。617条引用被确定，21项研究被纳入。487例患者暴露于霉酚酸盐。平均病程在0.8-14.1年之间。有18例死亡和90例非致命性不良事件。非致死性不良事件包括43例（47.7%）胃肠道事件、34例（26%）感染、6例（5%）细胞减少和2例（2%）恶性肿瘤。最常见的胃肠道事件包括腹泻（n=18(14%)）、恶心（n=12(9%)）和腹痛（n=3(2%)）。停药率在8%-40%之间。7项观察性研究报告了FVC的改善或稳定，5项研究报告了MRSS的稳定或改善。霉酚酸相关的胃肠道不良事件在SSc中很常见，但还没有严重到阻止其使用。观察数据提示霉酚酸酯可有效改善或稳定间质性肺疾病和皮肤受累。
Mycophenolate is increasingly being used in the rheumatic diseases. Its main adverse effects are gastrointestinal, myelosuppression, and infection. These may limit use in systemic sclerosis (SSc) since gastrointestinal involvement is common. The objective of this study is to evaluate gastrointestinal adverse events of mycophenolate in SSc. Secondarily we evaluated other adverse events, and the effectiveness of mycophenolate in skin and lung disease. A literature search of Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL (inception-2013) was performed. Studies reporting use of mycophenolate in SSc patients, adverse events, modified Rodnan skin score (MRSS), forced vital capacity (FVC), or diffusing capacity of carbon monoxide (DLCO) were included. The primary outcome was gastrointestinal events occurring after the initiation of mycophenolate. Secondary safety outcomes included myelosuppression, infection, malignancy, and death after the initiation of mycophenolate. 617 citations were identified and 21 studies were included. 487 patients were exposed to mycophenolate. The mean disease duration ranged between 0.8-14.1 years. There were 18 deaths and 90 non-lethal adverse events. The non-lethal adverse events included 43 (47.7%) gastrointestinal events, 34 (26%) infections, 6 (5%) cytopenias and 2 (2%) malignancies. The most common gastrointestinal events included diarrhea (n=18 (14%)), nausea (n=12 (9%)), and abdominal pain (n=3 (2%)). The rate of discontinuation ranged between 8%-40%. Seven observational studies reported improvement or stabilization in FVC, and 5 studies report stabilization or improvement in MRSS. Mycophenolate-associated gastrointestinal adverse events are common in SSc, but not severe enough to preclude its use. Observational data suggests mycophenolate may be effective in improving or stabilizing interstitial lung disease, and skin involvement.
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影响因子：
4.7
作者：
Hahn, Bevra H.;McMahon, Maureen A.;Wilkinson, Alan;Wallace, W. Dean;Daikh, David I.;Fitzgerald, John D.;Karpouzas, George A.;Merrill, Joan T.;Wallace, Daniel J.;Yazdany, Jinoos;Ramsey-Goldman, Rosalind;Singh, Karandeep;Khalighi, Mazdak;Choi, Soo-In;Gogia, Maneesh;Kafaja, Suzanne;Kamgar, Mohammad;Lau, Christine;Martin, William J.;Parikh, Sefali;Peng, Justin;Rastogi, Anjay;Chen, Weiling;Grossman, Jennifer M.
通讯作者：
Grossman, Jennifer M.
影响因子：
2.1
作者：
Bunnapradist, Suphamai;Ambuehl, Patrice M.
通讯作者：
Ambuehl, Patrice M.
影响因子：
27.4
作者：
Le, Elizabeth N.;Wigley, Fredrick M.;Hummers, Laura K.
通讯作者：
Hummers, Laura K.
影响因子：
6.2
作者：
Djamali A;Vidyasagar A;Yagci G;Huang LJ;Reese S
通讯作者：
Reese S
影响因子：
2.1
作者：
Arns, W;Breuer, S;Schmouder, R
通讯作者：
Schmouder, R