哮喘联盟

   摘要
   背景：白三烯受体拮抗剂(LTRAs)被推荐用于轻度哮喘的替代治疗，但是，与安慰剂相比疗效如何，尚不清楚。
   目的：本研究通过LTRAs单用或与吸入性糖皮质激素联用和安慰剂治疗成人和青少年哮喘的比较，来评估LTRAs的临床疗效与不良反应。
   数据来源：MEDLINE和Cochrane临床对照试验中心注册库，时间从建立至2015年6月。
   研究筛选：有关LTRAs与安慰剂治疗哮喘临床疗效对比的同行评审的、语言为英语的随机对照研究。
   数据提取：三位研究员针对研究人群、干预措施、结局指标和不良事件进行数据提取。另一位研究员则评估偏倚风险。
   资料综合：筛选出的2008篇摘要中，有50项研究符合入选标准。包括6项LTRAs单药治疗研究的随机效应荟萃分析显示，LTRAs有效降低哮喘急性发作风险(RR : 0.60; 95% CI : 0.44 - 0.81)。包括4项LTRAs与吸入性糖皮质激素联用的研究显示，哮喘急性发作的RR值为0.80 (95% CI: 0.60 - 1.07)。LTRAs单药治疗或与吸入性糖皮质激素联用，均可使FEV1增加，而FEV1占预计值百分比的改善仅体现于LTRAs单药治疗的研究中。治疗组和对照组不良事件的发生率类似。
   局限：各项研究中结局的定义和评价不一致，一些研究的偏倚风险较高，研究结果呈现异质性，可能出现的选择性结局报告偏倚，以及不能正确评估哮喘严重程度对总体风险预测的影响。
   结论：与安慰剂相比，LTRAs单药治疗可有效提高哮喘控制水平。但是，哪一类患者应用LTRAs治疗效果显著，暂不清楚。
 

（杨冬 审校）
Ann Intern Med. 2015 Nov 17;163(10):756-67. doi: 10.7326/M15-1059. Epub 2015 Sep 22.

 

Leukotriene-Receptor Antagonists Versus Placebo in the Treatment of Asthma in Adults and Adolescents: A Systematic Review and Meta-analysis.
 

Miligkos M, Bannuru RR, Alkofide H, Kher SR, Schmid CH, Balk EM.
 

Abstract
BACKGROUND:Leukotriene-receptor antagonists (LTRAs) are recommended as an alternative treatment in patients with mild asthma, but their effect compared with placebo is unclear.
PURPOSE:To determine the benefits and harms of LTRAs as monotherapy or in combination with inhaled corticosteroids compared with placebo in adults and adolescents with asthma.
DATA SOURCES:MEDLINE and the Cochrane Central Register of Controlled Trials from inception through June 2015.
STUDY SELECTION:Peer-reviewed, English-language, randomized, controlled trials in patients with asthma that reported the effect of LTRAs versus placebo on measures of asthma control.
DATA EXTRACTION:Three researchers extracted data on study population, interventions, outcome measures, and adverse events. One researcher assessed risk of bias.
DATA SYNTHESIS:Of the 2008 abstracts that were screened, 50 trials met eligibility criteria. Random-effects meta-analyses of 6 trials of LTRA monotherapy showed that LTRAs reduced the risk for an exacerbation (summary risk ratio [RR], 0.60 [95% CI, 0.44 to 0.81]). In 4 trials of LTRAs as add-on therapy to inhaled corticosteroids, the summary RR for exacerbation was 0.80 (CI, 0.60 to 1.07). Leukotriene-receptor antagonists either as monotherapy or as add-on therapy to inhaled corticosteroids increased FEV1, whereas FEV1 percentage of predicted values was improved only in trials of LTRA monotherapy. Adverse event rates were similar in the intervention and comparator groups.
LIMITATION:Variation in definitions and reporting of outcomes, high risk of bias in some studies, heterogeneity of findings, possible selective outcome reporting bias, and inability to assess the effect of asthma severity on summary estimates.
CONCLUSION:Leukotriene-receptor antagonists as monotherapy improved asthma control compared with placebo, but which patients are most likely to respond to treatment with LTRAs remains unclear.
 

Ann Intern Med. 2015 Nov 17;163(10):756-67. doi: 10.7326/M15-1059. Epub 2015 Sep 22.