Drug Treatment of Idiopathic Pulmonary Fibrosis Systematic Review and Network Meta-Analysis
Drug Treatment of Idiopathic Pulmonary Fibrosis Systematic Review and Network Meta-Analysis
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DOI：
10.1016/j.chest.2015.11.013
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发表时间：
2016-03-01
期刊：
影响因子：
9.6
通讯作者：
Devine, Beth E.
中科院分区：
文献类型：
--
作者：
Canestaro, William J.;Forrester, Sara H.;Devine, Beth E.
背景：特发性肺纤维化(IPF)是一种原因不明的慢性进行性纤维化性间质性肺疾病。最近，9tedanib和吡非尼酮证明了延缓疾病进展的效果，并获得了美国食品和药物管理局的批准。尽管在IPF中对多种治疗方法进行了评估，但没有一种方法显示死亡率显著下降。本研究的目的是确定所有对IPF进行评估的药物治疗，并通过贝叶斯网络荟萃分析和成对间接治疗比较来分析它们的疗效。方法：我们在MEDLINE、Embase和Cochrane图书馆中检索2014年8月或之前发表的研究。研究需要包含治疗IPF的非类固醇药物治疗的随机评估，并以英文发表。这项分析的关键结果是FVC测量的肺功能，以及所有原因和呼吸系统特有的死亡。所有结果通过贝叶斯框架进行分析。结果：我们的综述确定了30项符合条件的研究，评估了16种独特的治疗方法。在呼吸系统特有死亡率的固定效应和随机效应模型下，没有任何治疗方法比安慰剂效果更好。对于全因死亡率，在固定效应模型下，吡非尼酮和9tedanib的效应接近显著，可信区间略高于零。值得注意的是，在呼吸系统特有死亡率、全因死亡率和预计FVC百分比的下降方面，9tedanib和吡非尼酮几乎没有区别，也没有发现明显的优势。结论：尽管两种治疗IPF的方法都是基于肺功能下降的减少而被批准的，但在死亡率结果方面，这两种方法都没有明显的优势。
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a form of chronic progressive fibrosing interstitial lung disease of unknown origin. Recently, nintedanib and pirfenidone demonstrated efficacy in slowing disease progression and were approved by the US Food and Drug Administration. Although numerous treatments have been evaluated in IPF, none have shown significant decreases in mortality. The objective of this study was to identify all pharmacologic treatments evaluated for IPF and analyze their efficacy via Bayesian network meta-analysis and pairwise indirect treatment comparisons. This review did not evaluate the effect of steroid therapy.METHODS: We searched MEDLINE, Embase, and the Cochrane Library for studies published on or before August 2014. Studies were required to contain a randomized evaluation of nonsteroidal drug therapy for treatment of IPF and be published in English. Key outcomes of interest for this analysis were pulmonary function as measured by FVC as well as all-cause and respiratory-specific death. All outcomes were analyzed via a Bayesian framework.RESULTS: Our review identified 30 eligible studies that evaluated 16 unique treatments. Under both the fixed-effect and random-effect models for respiratory-specific mortality, no treatments performed better than placebo. For all-cause mortality, pirfenidone and nintedanib had effects approaching significance with credible intervals slightly crossing the null under a fixed-effect model. Notably, for respiratory-specific mortality, all-cause mortality, and decline in percent predicted FVC, nintedanib and pirfenidone were virtually indistinguishable and no clear advantage was detected.CONCLUSIONS: Although two treatments have been approved for IPF on the basis of reduced decline in pulmonary function, neither one has a clear advantage on mortality outcomes.