JNNP:抗Aβ药物治疗轻中度阿尔茨海默病的系统回顾和meta分析

2020-10-16 MedSci原创 MedSci原创

阿尔茨海默病(AD)在临床症状出现前几十年,伴随着淀粉样β(Aβ)肽斑块的沉积,这些斑块聚集在皮层和海马体。在早期阶段停止或逆转病理生理过程是晚期阶段的首选策略。在过去的20年中,

阿尔茨海默病(AD)在临床症状出现前几十年,伴随着淀粉样β(Aβ)肽斑块的沉积,这些斑块聚集在皮层和海马体。在早期阶段停止或逆转病理生理过程是晚期阶段的首选策略。在过去的20年中,人们一直在努力研究将Aβ靶向剂作为轻度至中度AD的潜在疾病缓解疗法(DMT)。本文研究目的在于研究Aβ靶向药物治疗轻中度阿尔茨海默病的疗效和安全性。

方法:采用MEDLINE,Embase,Cochrane对照试验中心注册中心,PsycINFO,世卫组织的国际临床试验注册平台搜索门户从成立到2020年4月都被搜索过。我们使用随机效应荟萃分析产生了集合估计。两名评审员(XZ和YG)独立筛选符合条件的全文研究的标题和摘要,并使用预定义的数据提取表从符合条件的研究中提取数据。从纳入的研究中收集的信息包括研究特征(例如,作者姓名、出版年份、研究设计和样本量);人群特征(例如,平均年龄、性别、种族、教育水平、基线MMSE、基线临床痴呆评分量表框总和(CDR-SOB)和AD程度;干预特征(例如,治疗方式、药物类型、剂量和研究治疗持续时间)、比较特征(例如,对照类型、治疗剂量和持续时间);以及结果(如ADAS Cog、ADCS-ADL、MMSE、CDR-SOB和随访时间)。对于有多个随访点、数据或报告的试验,我们收集了最长随访时间的结果数据。进行了试验序列分析(TSA),以避免由于稀疏数据和对累积数据的重复测试而产生的随机错误。

结果:19个随机对照试验,其中17个具有较低的偏倚风险,包括12个903个参与者。荟萃分析显示抗Aβ药物和安慰剂在阿尔茨海默病评估量表(ADAS Cog)的认知子量表(ADAS Cog)上没有差异(平均差异(MD):0.20,95%CI−0.40-0.81;I2=99.8%;最小重要差异3.1-3.8分,中度确定性证据)。对于ADAS Cog,结果表明,一种增加Aβ清除率的药物可能与降低Aβ生成的药物(MD:0.78,95%CI−0.99到−0.92)的效果不同(MD:0.78,95%CI 0.25-1.32)(相互作用p<0.000001);MMSE和CDR-SOB的结果也存在这种差异。与安慰剂组比较,抗Aβ药物相关不良事件依次为焦虑、抑郁、腹泻、疲劳、皮疹、晕厥和呕吐。

从目前的证据来看,抗Aβ干预不太可能对减缓认知或功能衰退产生重要影响。尽管亚组分析表明Aβ清除药物可能有益处,但该分析的可信度有限。

Lu LZheng XWang S, et al Anti-Aβ agents for mild to moderate Alzheimer's disease: systematic review and meta-analysis  

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    2020-11-25 一闲
  4. [GetPortalCommentsPageByObjectIdResponse(id=1818061, encodeId=f9d618180615f, content=<a href='/topic/show?id=4c9f9e777ac' target=_blank style='color:#2F92EE;'>#阿尔茨海#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97777, encryptionId=4c9f9e777ac, topicName=阿尔茨海)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Fri Jan 01 18:31:32 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1817038, encodeId=f563181e0380d, content=<a href='/topic/show?id=17b59e77626' target=_blank style='color:#2F92EE;'>#阿尔茨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97776, encryptionId=17b59e77626, topicName=阿尔茨)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Bnia2EtH2IvyBtniaWHPQOYAicsN3IAL1ZuPV7qyALcdCiawRJdEiafMxWTxzERQW7eeKg8HfCKCRK2CJicy073C4RJg/132, createdBy=464b2500186, createdName=ms1948154235210413, createdTime=Sat May 08 04:31:32 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896761, encodeId=bd941896e61a3, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Wed Nov 25 05:31:32 CST 2020, time=2020-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899417, encodeId=fb1889941e78, content=值得借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Mon Nov 16 00:05:01 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888227, encodeId=5e75188822e3c, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Jun 16 17:31:32 CST 2021, time=2021-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1470415, encodeId=3de614e0415dc, content=<a href='/topic/show?id=45a79e7788c' target=_blank style='color:#2F92EE;'>#阿尔茨海默#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97778, encryptionId=45a79e7788c, topicName=阿尔茨海默)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576410, encodeId=a3e915e6410c1, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1605271, encodeId=9b0116052e1f9, content=<a href='/topic/show?id=b820309108' target=_blank style='color:#2F92EE;'>#Aβ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3091, encryptionId=b820309108, topicName=Aβ)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee1c19366172, createdName=膀胱癌, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892738, encodeId=b262892e38a3, content=阿尔茨海默病的新药, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bb45125889, createdName=146465bem06暂无昵称, createdTime=Sun Oct 18 00:24:24 CST 2020, time=2020-10-18, status=1, ipAttribution=)]
    2020-11-16 心之方向

    值得借鉴

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1818061, encodeId=f9d618180615f, content=<a href='/topic/show?id=4c9f9e777ac' target=_blank style='color:#2F92EE;'>#阿尔茨海#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97777, encryptionId=4c9f9e777ac, topicName=阿尔茨海)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Fri Jan 01 18:31:32 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1817038, encodeId=f563181e0380d, content=<a href='/topic/show?id=17b59e77626' target=_blank style='color:#2F92EE;'>#阿尔茨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97776, encryptionId=17b59e77626, topicName=阿尔茨)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Bnia2EtH2IvyBtniaWHPQOYAicsN3IAL1ZuPV7qyALcdCiawRJdEiafMxWTxzERQW7eeKg8HfCKCRK2CJicy073C4RJg/132, createdBy=464b2500186, createdName=ms1948154235210413, createdTime=Sat May 08 04:31:32 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896761, encodeId=bd941896e61a3, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Wed Nov 25 05:31:32 CST 2020, time=2020-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899417, encodeId=fb1889941e78, content=值得借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Mon Nov 16 00:05:01 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888227, encodeId=5e75188822e3c, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Jun 16 17:31:32 CST 2021, time=2021-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1470415, encodeId=3de614e0415dc, content=<a href='/topic/show?id=45a79e7788c' target=_blank style='color:#2F92EE;'>#阿尔茨海默#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97778, encryptionId=45a79e7788c, topicName=阿尔茨海默)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576410, encodeId=a3e915e6410c1, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1605271, encodeId=9b0116052e1f9, content=<a href='/topic/show?id=b820309108' target=_blank style='color:#2F92EE;'>#Aβ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3091, encryptionId=b820309108, topicName=Aβ)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee1c19366172, createdName=膀胱癌, createdTime=Sun Oct 18 14:31:32 CST 2020, time=2020-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892738, encodeId=b262892e38a3, content=阿尔茨海默病的新药, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bb45125889, createdName=146465bem06暂无昵称, createdTime=Sun Oct 18 00:24:24 CST 2020, time=2020-10-18, status=1, ipAttribution=)]
    2021-06-16 guojianrong
  6. 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  7. 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  8. 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    2020-10-18 膀胱癌
  9. 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    2020-10-18 146465bem06暂无昵称

    阿尔茨海默病的新药

    0

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