Interleukin 2 receptor antagonists for renal transplant recipients: A meta-analysis of randomized trials
Interleukin 2 receptor antagonists for renal transplant recipients: A meta-analysis of randomized trials
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DOI：
10.1097/01.tp.0000109643.32659.c4
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发表时间：
2004-01-27
期刊：
影响因子：
6.2
通讯作者：
Craig, JC
中科院分区：
文献类型：
--
作者：
Webster, AC;Playford, EG;Craig, JC
背景白细胞介素2受体拮抗剂（IL-2 Ra）越来越多地用于治疗肾移植受者。本研究旨在系统地识别和总结使用IL-2 Ra的效果。作为诱导免疫抑制、作为标准治疗的补充、或作为其它抗体治疗的替代。广泛检索数据库、参考文献列表和会议论文摘要，以确定所有语言的相关随机对照试验。使用随机效应模型合成数据。结果以相对危险度（RR）和95%置信区间（CI）表示。共纳入了来自38项试验的117份报告，涉及4，893名受试者。当将IL-2 Ra与安慰剂（17项试验; 2，786例患者）进行比较时，1年（14项试验：RR 0.84; CI 0.64-1.10）或3年（4项试验：RR，1.08; CI 0.71-1.64）时移植物丢失无显著差异。急性排斥反应在6个月（12项试验：RR 0.66; CI 0.59-0.74）和1年（10项试验：RR 0.67; CI 0.60-0.75）时显著降低。1年时，巨细胞病毒感染（7项试验：RR 0.82; CI 0.65-1.03）和恶性肿瘤（9项试验：RR 0.67; CI 0.33-1.36）无显著差异。当IL-2 Ra.与其他抗体治疗相比，治疗效果无显著差异，但IL-2 Ra的副作用明显减少。考虑到40%的排斥风险，7名患者需要接受IL-2 Ra治疗。除了标准治疗外，还可以预防一例患者发生排斥反应，但移植物或患者存活率没有明显改善。巴利昔单抗和达利珠单抗之间没有明显差异。
Background. Interleukin 2 receptor antagonists (IL-2Ra) are increasingly used to treat renal transplant recipients. This study aims to systematically identify and summarize the effects of using IL-2Ra. as induction immunosuppression, as an addition to standard therapy, or as an alternative to other antibody therapy.Methods. Databases, reference lists, and abstracts of conference proceedings were searched extensively to identify relevant randomized controlled trials in all languages. Data were synthesized using the random effects model. Results are expressed as relative risk (RR), with 95% confidence intervals (CI).Results. A total of 117 reports from 38 trials involving 4,893 participants were included. When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or 3 years (4 trials: RR, 1.08; CI 0.71-1.64). Acute rejection was significantly reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10 trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials: RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were not significantly different. When IL-2Ra. were compared with other antibody therapy, no significant differences in treatment effects were demonstrated, but IL-2Ra, had significantly fewer side effects.Conclusions. Given a 40% risk of rejection, seven patients would need treatment with IL-2Ra. in addition to standard therapy, to prevent one patient from undergoing rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab.