Efficacy of Antiinflammatory Therapies for Adults With Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and Network Meta-Analysis.

Sustained neutrophilic inflammation is a key driver, prompting interest in antiinflammatory pharmacotherapy as a new treatment paradigm; however, comparisons among antiinflammatory agents are lacking.

持续的中性粒细胞炎症是关键驱动因素，引发了对抗炎药物治疗作为新的治疗范式的兴趣；然而，目前缺乏对不同抗炎药物的比较研究。

research_question

What is the current profile concerning efficacy and safety of antiinflammatory therapies for bronchiectasis?

关于支气管扩张症抗炎治疗的有效性和安全性，目前的情况如何？

study_design_and_methods

We performed a systematic reviewand network meta-analysisof randomized controlled trials that evaluated inhaled or oral antiinflammatory agents in adults with CT scan-confirmed bronchiectasis.

我们对评估了经CT扫描确诊的支气管扩张症成人的吸入或口服抗炎药物的随机对照试验进行了系统评价和网络荟萃分析。

PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched.

检索了PubMed、Embase、Cochrane对照试验注册中心、Web of Science、国际临床试验注册平台和ClinicalTrials.gov。

Trials enrolling adults and using ≥ 4 weeks of treatment were eligible.

符合纳入标准的试验为招募成人并使用≥4周治疗的试验。

The primary outcome was the rate of overall and severe exacerbations; secondary outcomes were quality of life, 6-minute walk distance, FEV1, and adverse events.

主要结果是总体和严重恶化的发生率；次要结果包括生活质量、6分钟步行距离、FEV1和不良事件。

The certainty of evidence was rated with Grading of Recommendations Assessment, Development, and Evaluation.

证据的确定性使用了推荐、评估、发展和评估的证据分级方法进行评估。

Results

Thirty-one trials (N = 4,092) evaluating 8 antiinflammatory agents were included.

纳入了31项试验（N = 4,092），评估了8种抗炎药物。

Compared with placebo, macrolides (rate ratio [RR], 0.44; 95% CI, 0.35-0.56) and dipeptidyl-peptidase-1 (DPP-1) inhibitors (RR, 0.73; 95% CI, 0.60-0.88) reduced overall exacerbation frequency (both moderate certainty).

与安慰剂相比，大环内酯类药物（率比[RR]，0.44；95%置信区间，0.35-0.56）和二肽基肽酶-1（DPP-1）抑制剂（RR，0.73；95%置信区间，0.60-0.88）均降低了总体恶化的频率（两者均为中等确定性）。

DPP-1 inhibitors reduced the frequency of severe exacerbations (RR, 0.70; 95% CI, 0.54-0.89; moderate certainty).

DPP-1抑制剂减少了严重发作的频率（相对风险，0.70；95%置信区间，0.54-0.89；中等确定性）

Macrolides showed a similar downward trend of severe exacerbations with very serious imprecision (RR, 0.54; 95% CI, 0.19-1.54; low certainty).

大环内酯类药物显示出类似减少严重发作的趋势，但存在非常严重的不精确性（相对风险，0.54；95%置信区间，0.19-1.54；低确定性）

Adverse events and treatment discontinuation rates were trivial or small for all interventions.

所有干预措施的不良事件和治疗中断率都很小或微不足道。

In subgroup analyses, DPP-1 inhibitors remained effective irrespective of baseline long-term macrolide use (with macrolide: RR, 0.77; 95% CI, 0.60-0.99; without macrolide: RR, 0.77; 95% CI, 0.67-0.89).

在亚组分析中，DPP-1抑制剂无论基线长期使用大环内酯类药物与否均保持有效（使用大环内酯类药物：相对风险 RR, 0.77; 95% 置信区间 CI, 0.60-0.99; 未使用大环内酯类药物：相对风险 RR, 0.77; 95% 置信区间 CI, 0.67-0.89）。

Among individual macrolides, azithromycin showed the greatest reduction in exacerbation frequency (RR, 0.37; 95% CI, 0.29-0.48).

在个体大环内酯类药物中，阿奇霉素显示出最大的减少发作频率的效果（相对风险 RR, 0.37; 95% 置信区间 CI, 0.29-0.48）。

interpretation

These findings support the use of DPP-1 inhibitors and macrolide antibiotics as antiinflammatory treatment options for bronchiectasis with frequent exacerbations.

这些发现支持使用 DPP-1 抑制剂和大环内酯类抗生素作为频繁发作的支气管扩张症的抗炎治疗选择。

clinical_trial_registration

PROSPERO; No.: CRD42024605694; URL: https://www.crd.york.ac.uk/prospero/.

PROSPERO; 编号：CRD42024605694; 网址：https://www.crd.york.ac.uk/prospero/