依洛尤单抗和阿利西尤单抗应用于急性冠状动脉综合征的网状Meta分析分析

Evolocumab and Alirocumab on Acute coronary syndrome: a network Meta-analysis

关键词:  依洛尤单抗  阿利西尤单抗  急性冠状动脉综合征  随机对照试验  网状Meta 分析

Key words:  Evolocumab  Alirocumab  Acute coronary syndrome  Randomized controlled trial  network Meta-analysis

摘要:

目的 评价依洛尤单抗和阿利西尤单抗治疗急性冠状动脉综合征（Acute coronary syndrome , ACS）的有效性、安全性。方法 检索国内外公开发表的依洛尤单抗和阿利西尤单抗治疗ACS的随机对照试验（Randomized controlled trials, RCT），检索时限从建库至2023 年6月，应用Stata15软件进行网状Meta分析比较两药之间的有效性和安全性。结果 共纳入22个RCT，包括 22339例患者。试验组药物为他汀类药物联合依洛尤单抗或阿利西尤单抗任意其中一种，对照组为单用他汀类药物或联合安慰剂。有效性方面，他汀基础上，依洛尤单抗和阿利西尤单抗在降低LDL-C、TG、TC、hs-CRP水平以及改善HDL-C代谢方面，两者均无显著差异(P>0.05)。安全性方面，两药的心血管不良事件发生率均无显著性差异(P>0.05)。结论 在ACS人群中，他汀联合依洛尤单抗或阿利西尤单抗治疗可明显改善脂质代谢、减少心血管不良事件的发生。两药之间的有效性和安全性比较差异无统计学意义 (P>0.05)。但本结论仍需大量多中心、大样本的RCT予以验证。

Abstract:

Objectives To systematically evaluated the efficacy and safety of Evolocumab and Alirocumab on Acute coronary syndrome (ACS). Methods The published at home and abroad of the Chinese and English databases were searched electronically for randomized controlled trials (RCT) of Evolocumab and Alirocumab on the treatment of ACS from inception to June 2023, and use Stata15 software to conduct a network Meta-analysis to compare the efficacy and safety of Evolocumab and Alirocumab. Results A total of 22 RCTs, involving 22339 patients were included. The drugs in the experimental group included statins combined with either Evolocumab or Alirocumab, and the control group was statins or statins combined with placebo. In terms of effectiveness, on a statin basis, Evolocumab and Alirocumab on reduce LDL-C, TG, TC, hs-CRP; and improving HDL-C levels, there was no significant difference between them (P > 0.05). In terms of safety, on a statin basis, the rate of adverse cardiovascular events, the difference was no significant (P > 0.05). Conclusion In the Acute coronary syndrome population, statin combined with Evolocumab or Alirocumab significantly improved lipid metabolism and reduced the incidence of adverse cardiovascular events. There was no significant difference in the incidence of efficacy and safety between the Evolocumab or Alirocumab. But the conclusions of this study need to be verified by large, multicenter, large-sample clinical randomized controlled trials.