Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis
Aims: This study was designed to determine whether treatments with tacrolimus would provide benefit for patients with myasthenia gravis (MG). Materials and Methods: The databases of Medline, EMBASE, the Cochrane Library, and four Chinese databases were searched for eligible studies. Weighted mean d...
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doaj-2a8e2062c1814adb99d1184e6530a9262020-11-24T20:54:36ZengWolters Kluwer Medknow PublicationsAnnals of Indian Academy of Neurology0972-23271998-35492017-01-0120434134710.4103/aian.AIAN_97_17Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysisZuojie ZhangChunsong YangLingli ZhangQiusha YiZilong HaoAims: This study was designed to determine whether treatments with tacrolimus would provide benefit for patients with myasthenia gravis (MG). Materials and Methods: The databases of Medline, EMBASE, the Cochrane Library, and four Chinese databases were searched for eligible studies. Weighted mean differences and standardized mean differences (SMD) with corresponding 95% confidence intervals (CIs) were used to summarize the primary outcome, namely, steroid-sparing effect of tacrolimus in maintaining minimal manifestations, and the secondary outcome, namely, the effect of tacrolimus in reducing the severity of MG, respectively. Results: After systematic retrieval, 13 researches with two randomized controlled trials (RCTs) and 11 prospective open-label single-arm clinical trials were included in the study. For the primary outcome of two RCTs, one RCT which was followed up for 1 year showed a positive effect and the other RCT which was associated with treatment duration of 28 weeks showed a negative result. For the secondary outcome, meta-analyses of other 11 trials showed a benefit effect, overall. For the quantitative MG (QMG) score, there were significant differences with high heterogeneity (SMD: 2.93; 95% CI: 1.14–4.73; I2 = 86%). In contrast, for MG activities of daily living (MGADL) score, it was reduced by tacrolimus with significant SMD and less heterogeneity (SMD: 0.59; 95% CI: 0.33–0.85; I2 = 7%). Adverse effects were mentioned as mild. Discussion: The opposite results of two RCTs showed that tacrolimus with enough treatment duration might have positive steroid-sparing effect. The most possible cause of heterogeneity in the outcome of QMG score between trials was the baseline severity of MG. Conclusion: The above finding suggests that there might be a potential beneficial role with no serious side effects of tacrolimus, and additional better RCTs including larger sample sizes and long-term study are needed to confirm or refute the results.http://www.annalsofian.org/article.asp?issn=0972-2327;year=2017;volume=20;issue=4;spage=341;epage=347;aulast=ZhangEfficacymeta-analysismyasthenia gravissafetytacrolimus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zuojie Zhang Chunsong Yang Lingli Zhang Qiusha Yi Zilong Hao |
spellingShingle |
Zuojie Zhang Chunsong Yang Lingli Zhang Qiusha Yi Zilong Hao Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis Annals of Indian Academy of Neurology Efficacy meta-analysis myasthenia gravis safety tacrolimus |
author_facet |
Zuojie Zhang Chunsong Yang Lingli Zhang Qiusha Yi Zilong Hao |
author_sort |
Zuojie Zhang |
title |
Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis |
title_short |
Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis |
title_full |
Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis |
title_fullStr |
Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis |
title_full_unstemmed |
Efficacy and safety of tacrolimus in myasthenia gravis: A systematic review and meta-analysis |
title_sort |
efficacy and safety of tacrolimus in myasthenia gravis: a systematic review and meta-analysis |
publisher |
Wolters Kluwer Medknow Publications |
series |
Annals of Indian Academy of Neurology |
issn |
0972-2327 1998-3549 |
publishDate |
2017-01-01 |
description |
Aims: This study was designed to determine whether treatments with tacrolimus would provide benefit for patients with myasthenia gravis (MG). Materials and Methods: The databases of Medline, EMBASE, the Cochrane Library, and four Chinese databases were searched for eligible studies. Weighted mean differences and standardized mean differences (SMD) with corresponding 95% confidence intervals (CIs) were used to summarize the primary outcome, namely, steroid-sparing effect of tacrolimus in maintaining minimal manifestations, and the secondary outcome, namely, the effect of tacrolimus in reducing the severity of MG, respectively. Results: After systematic retrieval, 13 researches with two randomized controlled trials (RCTs) and 11 prospective open-label single-arm clinical trials were included in the study. For the primary outcome of two RCTs, one RCT which was followed up for 1 year showed a positive effect and the other RCT which was associated with treatment duration of 28 weeks showed a negative result. For the secondary outcome, meta-analyses of other 11 trials showed a benefit effect, overall. For the quantitative MG (QMG) score, there were significant differences with high heterogeneity (SMD: 2.93; 95% CI: 1.14–4.73; I2 = 86%). In contrast, for MG activities of daily living (MGADL) score, it was reduced by tacrolimus with significant SMD and less heterogeneity (SMD: 0.59; 95% CI: 0.33–0.85; I2 = 7%). Adverse effects were mentioned as mild. Discussion: The opposite results of two RCTs showed that tacrolimus with enough treatment duration might have positive steroid-sparing effect. The most possible cause of heterogeneity in the outcome of QMG score between trials was the baseline severity of MG. Conclusion: The above finding suggests that there might be a potential beneficial role with no serious side effects of tacrolimus, and additional better RCTs including larger sample sizes and long-term study are needed to confirm or refute the results. |
topic |
Efficacy meta-analysis myasthenia gravis safety tacrolimus |
url |
http://www.annalsofian.org/article.asp?issn=0972-2327;year=2017;volume=20;issue=4;spage=341;epage=347;aulast=Zhang |
work_keys_str_mv |
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