The Inhibition of Complement System in Formal and Emerging Indications: Results from Parallel One-Stage Pairwise and Network Meta-Analyses of Clinical Trials and Real-Life Data Studies.

Details

Serval ID
serval:BIB_A5D098516B01
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The Inhibition of Complement System in Formal and Emerging Indications: Results from Parallel One-Stage Pairwise and Network Meta-Analyses of Clinical Trials and Real-Life Data Studies.
Journal
Biomedicines
Author(s)
Bernuy-Guevara C., Chehade H., Muller Y.D., Vionnet J., Cachat F., Guzzo G., Ochoa-Sangrador C., Álvarez F.J., Teta D., Martín-García D., Adler M., de Paz F.J., Lizaraso-Soto F., Pascual M., Herrera-Gómez F.
ISSN
2227-9059 (Print)
ISSN-L
2227-9059
Publication state
Published
Issued date
16/09/2020
Peer-reviewed
Oui
Volume
8
Number
9
Pages
E355
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
This manuscript presents quantitative findings on the actual effectiveness of terminal complement component 5 (C5) inhibitors and complement component 1 (C1) esterase inhibitors through their formal and common "off-label" (compassionate) indications. The results emanated from pairwise and network meta-analyses to present evidence until September 2019. Clinical trials (CT) and real-life non-randomized studies of the effects of interventions (NRSI) are consistent on the benefits of C5 inhibitors and of the absence of effects of C1 esterase inhibitors (n = 7484): Mathematically, eculizumab (surface under the cumulative ranking area (SUCRA) >0.6) and ravulizumab (SUCRA ≥ 0.7) were similar in terms of their protective effect on hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), thrombotic microangiopathy (TMA) in atypical hemolytic uremic syndrome (aHUS), and acute kidney injury (AKI) in aHUS, in comparison to pre-/off-treatment state and/or placebo (SUCRA < 0.01), and eculizumab was efficacious on thrombotic events in PNH (odds ratio (OR)/95% confidence interval (95% CI) in CT and real-life NRSI, 0.07/0.03 to 0.19, 0.24/0.17 to 0.33) and chronic kidney disease (CKD) occurrence/progression in PNH (0.31/0.10 to 0.97, 0.66/0.44 to 0.98). In addition, meta-analysis on clinical trials shows that eculizumab mitigates a refractory generalized myasthenia gravis (rgMG) crisis (0.29/0.13 to 0.61) and prevents new acute antibody-mediated rejection (AMR) episodes in kidney transplant recipients (0.25/0.13 to 0.49). The update of findings from this meta-analysis will be useful to promote a better use of complement inhibitors, and to achieve personalization of treatments with this class of drugs.
Keywords
biological products, complement inactivating agents, meta-analysis as topic
Pubmed
Web of science
Open Access
Yes
Create date
28/09/2020 12:46
Last modification date
11/11/2020 7:24
Usage data