Efficacité et innocuité du tacrolimus dans la myasthénie grave: examen systématique et méta-analyse.

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Efficacité et innocuité du tacrolimus dans la myasthénie grave: examen systématique et méta-analyse.

Message par Pboulanger » 01 déc. 2017 12:26

:hi:

:arrow: Lu sur :https://www.ncbi.nlm.nih.gov/pubmed/29184334

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Efficacy and Safety of Tacrolimus in Myasthenia Gravis: A Systematic Review and Meta-analysis.
Zhang Z1,2,3, Yang C1,2, Zhang L1,2, Yi Q3, Hao Z4.
Ann Indian Acad Neurol. 2017 Oct-Dec;20(4):341-347. doi: 10.4103/aian.AIAN_97_17.


Abstract
  • Aims:

    This study was designed to determine whether treatments with tacrolimus would provide benefit for patients with myasthenia gravis (MG).
    Materials and Methods:

    The databases of Medline, EMBASE, the Cochrane Library, and four Chinese databases were searched for eligible studies. Weighted mean differences and standardized mean differences (SMD) with corresponding 95% confidence intervals (CIs) were used to summarize the primary outcome, namely, steroid-sparing effect of tacrolimus in maintaining minimal manifestations, and the secondary outcome, namely, the effect of tacrolimus in reducing the severity of MG, respectively.
  • Results:

    After systematic retrieval, 13 researches with two randomized controlled trials (RCTs) and 11 prospective open-label single-arm clinical trials were included in the study.
    For the primary outcome of two RCTs, one RCT which was followed up for 1 year showed a positive effect and the other RCT which was associated with treatment duration of 28 weeks showed a negative result. For the secondary outcome, meta-analyses of other 11 trials showed a benefit effect, overall.
    For the quantitative MG (QMG) score, there were significant differences with high heterogeneity (SMD: 2.93; 95% CI: 1.14-4.73; I2 = 86%).
    In contrast, for MG activities of daily living (MGADL) score, it was reduced by tacrolimus with significant SMD and less heterogeneity (SMD: 0.59; 95% CI: 0.33-0.85; I2 = 7%). Adverse effects were mentioned as mild.
  • Discussion:

    The opposite results of two RCTs showed that tacrolimus with enough treatment duration might have positive steroid-sparing effect. The most possible cause of heterogeneity in the outcome of QMG score between trials was the baseline severity of MG.
  • Conclusion:

    The above finding suggests that there might be a potential beneficial role with no serious side effects of tacrolimus, and additional better RCTs including larger sample sizes and long-term study are needed to confirm or refute the results.
Message de : Pboulanger  un membre de l'équipe technique
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