Influence of smoking on the efficacy of antimalarials in cutaneous lupus: A meta-analysis of the literature
Influence of smoking on the efficacy of antimalarials in cutaneous lupus: A meta-analysis of the literature
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DOI：
10.1016/j.jaad.2014.12.025
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发表时间：
2015-04-01
影响因子：
13.8
通讯作者：
Arnaud, Laurent
中科院分区：
文献类型：
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作者：
Chasset, Francois;Frances, Camille;Arnaud, Laurent
背景：抗疟药是治疗皮肤红斑狼疮（CLE）的主要药物，吸烟与抗疟药疗效之间的相互作用仍存在争议。目的：我们系统地回顾了这种相互作用的证据，并进行了荟萃分析，比较了吸烟者和非吸烟者CLE患者抗疟药物的疗效。方法：选取截至2014年3月在MEDLINE、Embase和Cochrane数据库中发表的观察性研究，根据吸烟状况报道抗疟药物治疗CLE的疗效。吸烟与皮肤反应率之间的关联强度用比值比表示。个体研究的优势比在荟萃分析中使用随机效应模型进行组合。结果：在检索到的240篇引文中，有10篇研究符合纳入标准，共计1398例患者。与非吸烟者（n = 601）相比，吸烟的CLE患者（n = 797）抗疟药物疗效的合并优势比为0.53（95%可信区间0.29-0.98）。局限性：由于缺乏可用数据，无法对考虑CLE亚型、类型和抗疟药物剂量的抗疟药物反应进行亚组分析。结论：吸烟与使用抗疟药物后皮肤改善的CLE患者比例降低2倍有关。对于CLE和难治性皮肤受累的患者，应考虑戒烟。
Background: Interaction between smoking and efficacy of antimalarials, the mainstay of treatment for cutaneous lupus erythematosus (CLE), remains controversial.Objectives: We systematically reviewed the evidence for such an interaction and performed a meta-analysis to compare the efficacy of antimalarials among smoker versus nonsmoker patients with CLE.Methods: Observational studies published up to March 2014 in the MEDLINE, Embase, and Cochrane databases were selected if they reported on the efficacy of antimalarials for treatment of CLE, according to smoking status. The strength of association between smoking and cutaneous response rate was expressed using the odds ratio. Individual study odds ratios were combined in the meta-analysis using a random effects model.Results: Of 240 citations retrieved, 10 studies met inclusion criteria, for a total of 1398 patients. The pooled odds ratio for the response to antimalarials in smoker patients with CLE (n = 797) was 0.53 (95% confidence interval 0.29-0.98) compared with nonsmokers (n = 601).Limitations: Subgroup analyses for the response to antimalarials considering CLE subtypes, type, and dosage of antimalarials could not be performed because of the lack of available data.Conclusions: Smoking is associated with a 2-fold decrease in the proportion of patients with CLE achieving cutaneous improvement with antimalarials. Smoking cessation should be considered in patients with CLE and refractory cutaneous involvement.