Comparative Efficacy of Radioiodine Therapy With Adjunctive Thionamides vs Either Treatment Alone in the Management of Graves Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background

This systematic reviewand meta-analysisof randomized controlled trials (RCTs) aimed to evaluate the success (hypothyroidism/euthyroid) and failure (hyperthyroidism/relapse) of adjunctive (pre-RAI/post-RAI/both) and monotherapy with ATDs in Graves disease.

这项系统评价和随机对照试验(RCTs)的荟萃分析旨在评估在格雷夫斯病中，ATDs的辅助治疗（RAI前/RAI后/两者）和单一治疗的成功（甲状腺功能减退/甲状腺功能正常）与失败（甲状腺功能亢进/复发）情况。

Methods

PubMed, CENTRAL, Scopus, and Web of Science were searched to December 2023 for RCTs on adjunctive ATDs with RAI or ATDs monotherapy in adults.

检索了PubMed、CENTRAL、Scopus和Web of Science数据库，直至2023年12月，以寻找关于成人辅助抗甲状腺药物(ATDs)联合放射性碘(RAI)治疗或ATDs单一治疗的随机对照试验(RCTs)。

Pooled relative risks were estimated using a random-effects model.

使用随机效应模型估计了合并相对风险。

Certainty of findings was assessed with GRADE.

使用GRADE方法评估了研究结果的确定性。

Results

We included 21 RCTs (1914 participants).

我们纳入了21项随机对照试验（共1914名参与者）。

Adjunctive ATDs showed no significant effect on success (RR: 0.96, 95% CI: 0.91-1.01) or failure (RR: 1.17, 95% CI: 0.97-1.42) rate (moderate GRADE) but increased the chance of euthyroid state and reduced hypothyroidism (RR: 0.67, 95% CI: 0.50-0.90) compared to RAI.

附加抗甲状腺药物(ATDs)对成功率(RR: 0.96, 95% 置信区间: 0.91-1.01)或失败率(RR: 1.17, 95% 置信区间: 0.97-1.42)没有显著影响(中等GRADE)，但增加了 euthyroid 状态的可能性并减少了甲状腺功能减退症(RR: 0.67, 95% 置信区间: 0.50-0.90)与 RAI 相比。

ATDs monotherapy vs RAI with adjunctive ATDs showed no significant difference in resolving hyperthyroidism (RR: 0.93, 95% CI: 0.84-1.02).

ATDs 单药治疗与 RAI 加用 ATDs 相比，在解决甲状腺功能亢进方面没有显著差异(RR: 0.93, 95% 置信区间: 0.84-1.02)。

Propylthiouracil with RAI was associated with reduced likelihood of success (RR: 0.81, 95% CI: 0.69-0.96).

与放射性碘（RAI）联合使用丙硫氧嘧啶与降低治疗成功率相关（相对风险RR: 0.81, 95% 置信区间CI: 0.69-0.96）。

Conclusions

ATDs do not significantly affect the success or failure rates of RAI therapy, particularly in long-term follow-up, but they may improve euthyroid outcomes and reduce hypothyroidism.

抗甲状腺药物（ATDs）对放射性碘（RAI）治疗的成功或失败率没有显著影响，特别是在长期随访中，但它们可能改善甲状腺功能正常的结果并减少甲状腺功能减退。

Long-term ATD monotherapy showed no significant difference compared with RAI in resolving hyperthyroidism; however, additional long-term trials are needed to confirm these findings.

长期单一使用抗甲状腺药物治疗与放射性碘治疗在解决甲状腺功能亢进方面没有显著差异；然而，需要额外的长期试验来确认这些发现。

Management of Graves disease requires individualized physician-patient decisions.

格雷夫斯病的管理需要根据医生和患者之间的个体化决策。