摘要
目的评价艾多沙班治疗癌症相关静脉血栓栓塞症(CAVTE)的有效性、安全性及经济性。方法采用计算机检索PubMed、The Cochrane Library、CRD Web、中国知网(CNKI)、万方(WanFang)数据库及国内外卫生技术评估(HTA)机构的官方网站,检索时限为自建库起至2023年8月31日。由2名评价者根据纳入与排除标准独立筛选文献并提取数据,采用HTA checklist、AMSTAR2量表或CHEERS 2022量表对纳入文献进行质量评价,采用描述性分析法对提取的研究内容进行分析和总结。结果共检索到相关文献514篇,最终纳入9篇系统评价/Meta分析、4篇药物经济学研究。研究结果显示,在有效性方面,艾多沙班治疗CAVTE,减少静脉血栓栓塞症复发的疗效优于华法林(P<0.05),与低分子肝素(LMWH)、利伐沙班、阿哌沙班的疗效相当(P>0.05);减少肺栓塞复发的疗效与LMWH相当(P>0.05);减少深静脉血栓形成复发的疗效优于LMWH(P<0.05)。在安全性方面,艾多沙班发生大出血的风险高于LMWH(P<0.05),与华法林、阿哌沙班、利伐沙班相当(P>0.05);发生临床相关非大出血的风险低于华法林(P<0.05),与LMWH、阿哌沙班、利伐沙班相当(P>0.05);发生临床相关出血的风险高于LMWH(P<0.05),低于利伐沙班(P<0.05),与阿哌沙班相当(P>0.05)。在经济性方面,国外的研究结果显示,艾多沙班较LMWH治疗CAVTE具有成本-效用优势。结论艾多沙班治疗CAVTE的有效性和安全性均较好,国外的研究提示经济性良好,但缺乏国内的药物经济学研究。
Objective To evaluate the efficacy,safety,and cost-effectiveness of edoxaban in the treatment of cancer-associated venous thromboembolism(CAVTE).Methods PubMed,The Cochrane Library,CRD Web,CNKI,WanFang database,and official websites of domestic and foreign health technology assessment(HTA)institutions were searched from their inception to August 31,2023.Two reviewers independently screened the literature and extracted data according to inclusion and exclusion criteria.The HTA checklist and AMSTAR2 or CHEERS 2022 scales were used to evaluate the quality of the included literature.Descriptive analysis was used to analyze and summarize the extracted research content.Results A total of 514 relevant studies were retrieved,and nine systematic reviews/Meta-analyses and four pharmacoeconomic studies were ultimately included.The results showed that in terms of effectiveness,the efficacy of edoxaban in treating CAVTE and reducing the recurrence of venous thromboembolism was better than that of warfarin(P<0.05),which was comparable to that of low molecular weight heparin(LMWH),rivaroxaban,and apixaban(P>0.05);the efficacy of edoxaban in reducing pulmonary embolism recurrence was comparable to that of LMWH(P>0.05),but the efficacy of edoxaban in reducing deep vein thrombosis recurrence was better than that of LMWH(P<0.05).In terms of safety,edoxaban had a higher risk of major bleeding than LMWH(P<0.05),but it had a similar risk to warfarin,apixaban and rivaroxaban(P>0.05);edoxaban had a lower risk of clinically relevant non-major bleeding than warfarin(P<0.05),but it had a similar risk to LMWH,apixaban and rivaroxaban(P>0.05);edoxaban had a higher risk of clinically relevant bleeding than LMWH(P<0.05),and had a lower risk than rivaroxaban(P<0.05),but had a similar risk to apixaban(P>0.05).In terms of economy,foreign researches showed that edoxaban had a cost-utility advantage in treating CAVTE than LMWH.Conclusion Edoxaban is effective and safe in the treatment of CAVTE,and foreign researches suggested that it is economical.However,there is no domestic pharmacoeconomic research.
作者
孟佳佳
王陈萍
王丹丹
陈敏
窦志华
MENG Jiajia;WANG Chenping;WANG Dandan;CHEN Min;DOU Zhihua(Nantong Third People's Hospital·Affiliated Nantong Third Hospital of Nantong University,Nantong,Jiangsu,China 226006)
出处
《中国药业》
CAS
2024年第17期122-126,共5页
China Pharmaceuticals
基金
江苏省药学会-恒瑞医院药学基金项目[H202319]
江苏省南通市药师协会-药物政策与药学服务研究项目[2023NTPA10]。
