Comprehensive evaluation of the efficacy,quality of survival,and safety of tacrolimus in the treatment of myasthenia gravis:a meta-analysis
Objective To evaluate the efficacy,quality of survival,andsafetyof tacrolimus in the treatment of myasthenia gravis by meta-analysis.Methods We searched CNKI,Wanfang Database,Vip Database,Web of Science,OVID,and Cochrane Library Database,and extracted the control studies of tacrolimus in the treatment of myasthenia gravis from the establishment of databases to May 2023.According to the inclusion and exclusion criteria,two researchers independently screened the literatures,extracted the data,and evaluated the quality of included literatures by using the risk bias evaluation tool of Cochrane Collaboration Network.The data were analyzed by using RevMan 5.3 software.Results A total of 1 007 patients were included in 14 studies,including 521 patients in the experimental group and 486 patients in the control group.The results of meta-analysis showed that the effective rate of the experimental group was higher than that of the control group[OR=5.68,95％CI(3.33,9.67),P＜0.000 01];the score of activities of daily living(ADL)in the experimental group was higher than that in the control group[SMD=1.3 7,95％CI(1.10,1.64),P＜0.000 01];the Quantitative MG Scoring System(QMG)score of the experimental group was lower than that of the control group[SMD=-0.47,95％CI(-0.86,-0.09),P=0.02];the 6 indexes of Busch score(role function,physical function,cognitive function,6 vital forces,social function,and emotional function)in the experimental group were lower than those in the control group[SMD=-1.17,95％CI(-1.50,-0.85),P＜0.000 01;SMD=-1.72,95％CI(-2.07,-1.37),P＜0.000 01;SMD=-0.69,95％CI(-1.0 0,-0.39),P＜0.000 01;SMD=-1.15,95％CI(-1.47,-0.8 3),P＜0.000 01;SMD=-1.98,95％CI(-2.67,-1.29),P＜0.000 01;SMD=-0.69,95％CI(-1.00,-0.39),P＜0.000 01;SMD=-1.14,95％CI(-1.78,-0.49),P=0.000 5];the Manual Muscle Test(MMT)score of the experimental group was lower than that of the control group[SMD=-2.09,95％CI(-2.8 0,-1.39),P＜0.000 01];there was no statistically significant difference in the Xu's absolute score between the experimental group and the control group[SMD=-0.34,95％CI(-0.87,0.19),P=0.21];there was no statistically significant difference in the incidence of adverse reactions between the experimental group and the control group[OR=0.93,95％CI(0.48,-1.80),P=0.83].Conclusion Tacrolimus can better improve the severity of myasthenia gravis patients and improve the patients'quality of life,with reliable safety.However,due to the quality limitation of the included studies,large-sample,multi-center,and high-quality randomized controlled trials are still needed to confirm its clinical efficacy and safety.
TacrolimusMyasthenia gravisCurative effectQuality of survivalSafetyMeta-analysis
万方数据
维普
