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首页> 外文期刊>European Journal of Haematology >Network meta‐analysis of first‐line treatments in transplant‐ineligible multiple myeloma patients
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Network meta‐analysis of first‐line treatments in transplant‐ineligible multiple myeloma patients

机译:移植式无骨髓瘤患者的一线治疗网络荟萃分析

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摘要

Abstract Objectives Multiple myeloma (MM) is a complex disease. Lack of direct comparisons among treatments and incorporation of new alternatives make it necessary to perform studies that allow for clinical decision‐making. A network meta‐analysis (NMA) was developed to evaluate the comparative efficacy among different therapeutic alternatives in newly diagnosed transplant‐ineligible MM patients. Methods MEDLINE ? and EMBASE ? were systematically searched up for these drugs: lenalidomide, thalidomide, bortezomib, and daratumumab. Comparative phase II‐III randomized clinical trials (RCTs) were included. Progression‐free survival (PFS) was selected as efficacy outcome. The NMA was developed using Bayesian methods. Fixed‐ and random‐effects models were assessed using deviance information criteria. Results The systematic search yielded 593 results. Ten RCTs were included. No differences were observed between fixed‐ and random‐effects models. The combination of daratumumab, bortezomib, melphalan, and prednisone showed the best HR in PFS (reference treatment). Along with this scheme, the best PFS results were obtained by combination of daratumumab, lenalidomide, and dexamethasone (HR 1.2, 95% CrI 0.64‐2.4) and bortezomib with lenalidomide and dexamethasone (HR 1.6, 95% CrI 0.81‐3.0). Conclusions Schemes with the best PFS results were daratumumab treatments and combination of bortezomib, lenalidomide, and dexamethasone, although the latter scheme has been analyzed in heterogeneous populations.
机译:摘要目标多发性骨髓瘤(mm)是一种复杂的疾病。治疗中缺乏直接比较和新替代品的纳入使得有必要进行允许临床决策的研究。开发了网络元分析(NMA)以评估新诊断的移植型患者的不同治疗替代品之间的比较疗效。方法medline?并开设?系统地搜索这些药物:Lenalidomide,沙利度胺,Bortezomib和Daratumumab。将比较期III-III随机化临床试验(RCT)包括在内。选择无进展的存活(PFS)作为疗效结果。 NMA是使用贝叶斯方法开发的。使用偏差信息标准评估固定和随机效果模型。结果系统搜索产生了593个结果。包括十个RCT。在固定和随机效应模型之间没有观察到差异。达拉姆拉夫,硼溴虫草,梅酚和泼尼松的组合显示了PFS中最佳的HR(参考处理)。随着该方案,通过达拉努马姆,萘醛胺和地塞米松(HR 1.2,95%CRI 0.64-2.4)和硼替佐米的组合获得了最佳的PFS结果,并​​用Lenalidomide和地塞米松(HR 1.6,95%CRI 0.81-3.0)。结论具有最佳PFS结果的方案是Daratumumab治疗和Bortezomib,Lenalidomide和地塞米松的组合,尽管后一种方案已经在异质群体中分析。

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