Does zafirlukast reduce future risk of asthma exacerbations in adults? Systematic review and meta-analysis.
Does zafirlukast reduce future risk of asthma exacerbations in adults? Systematic review and meta-analysis.
复制标题
扎鲁司特是否可以降低成人未来哮喘恶化的风险？
DOI：
10.1186/2049-6958-9-30
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发表时间：
2014
影响因子：
2.3
通讯作者：
Wang G
中科院分区：
文献类型：
--
作者：
Chen CF;Lv Y;Zhang HP;Wang G
背景与目的哮喘管理的目的是实现包括当前控制和未来风险在内的哮喘总体控制。它已被证明在减少哮喘急性发作的疗效，但扎鲁司特的效果大小的哮喘急性发作的各种严重程度是没有系统explored.MethodsRandomized对照试验中检索PubMed中央，Web的科学，和Embase，扎鲁司特预防哮喘急性发作的成人。主要结局是哮喘急性发作，次要结局分别是需要全身皮质类固醇和急诊访视的哮喘急性发作。优势比（OR）与95%的置信区间（CI）进行了汇总。作为一线治疗，与接受安慰剂的患者相比，接受扎鲁司特治疗的慢性哮喘患者的哮喘急性发作发生率在统计学上较低（OR = 0.68，95% CI = [0.45，1.00]），但在需要全身皮质类固醇的哮喘急性发作中，未发现扎鲁司特上级优于安慰剂（OR = 0.76，95%CI = [0.45，1.29]）。此外，扎鲁司特在哮喘急性发作（OR = 2.11，95% CI = [1.35，3.30]）和需要全身皮质类固醇（OR = 3.71，95% CI = [1.82，7.59]）方面劣于IC。作为添加治疗，扎鲁司特在哮喘急性发作（OR =0.99，95%CI = [0.54，1.81]）和需要急诊访视（OR = 0.72，95%CI = [0.18，2.99]）方面并不上级安慰剂。有趣的是，扎鲁司特和IC之间的哮喘急性发作没有显著差异（OR = 1.12，95%CI = [0.53，2.34]）。结论我们的研究表明，扎鲁司特，作为一线治疗，显着减少轻至中度，但不是重度哮喘急性发作。扎鲁司特在添加治疗方案中不能减少哮喘急性发作，这可能是由于样本量小，需要进一步研究。
Background and objectiveThe purpose of asthma management is to achieve a total asthma control that involves current control and future risk. It has proven efficacy in reducing asthma exacerbations, but the effect size of zafirlukast for asthma exacerbations of various severity is not systematically explored.MethodsRandomized controlled trials were searched in PubMed Central, Web of Science, and Embase, where zafirlukast prevented asthma exacerbations in adults. The primary outcome was asthma exacerbations, the secondary outcomes were asthma exacerbations requiring systemic corticosteroids and emergency visits, respectively. Odds ratio (OR) with 95% confidence intervals (CI) were pooled.ResultsTwelve trials were identified. As first-line therapy, compared to those having placebo, the patients with chronic asthma receiving zafirlukast experienced statistically lower asthma exacerbations (OR = 0.68, 95% CI = [0.45, 1.00]), but it was not found that zafirlukast was superior to placebo in asthma exacerbations requiring systemic corticosteroids (OR = 0.76, 95% CI = [0.45, 1.29]). Furthermore, zafirlukast was inferior to ICs in asthma exacerbations (OR = 2.11, 95% CI = [1.35, 3.30]) and requiring systemic corticosteroids (OR = 3.71, 95% CI = [1.82, 7.59]). As add-on therapy, zafirlukast was not superior to placebo in asthma exacerbations (OR =0.99, 95% CI = [0.54, 1.81] and requiring emergency visits (OR = 0.72, 95% CI = [0.18, 2.99]). Intriguingly, there was not a significant difference in asthma exacerbations between zafirlukast and ICs (OR = 1.12, 95% CI = [0.53, 2.34]).ConclusionsOur study suggests that zafirlukast, as the first-line therapy, significantly reduces mild to moderate but not severe asthma exacerbations. In the add-on regimen, zafirlukast could not reduce asthma exacerbations, which would perhaps result from small sample size and needsto be further studied.