Pharmacological treatment of abdominal aortic aneurysm: a systematic review and network Meta-analysis

doi:10.3877/cma.j.issn.1674-0785.2023.12.011

Abstract

Abstract:

Objective

To identify potential therapeutic agents for abdominal aortic aneurysm (AAA) patients by conducting a network Meta-analysis (NMA) and systematic review.

Methods

A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane to identify randomized controlled trials (RCTs) on patients with AAA for further analysis. The primary outcome was AAA events, which were defined as AAA dilation or rupture. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the drugs. The Bayesian framework was used in an NMA to investigate drugs that could prevent dilatation and rupture of AAA.

Results

A total of 10 RCTs including 2234 patients with AAA were included. Patients under pharmacological therapies exhibited a comparable incidence of AAA events to those treated with placebo, with a pooled relative risk (RR) of 0.85 (95% confidence interval [CI]: 0.28-2.58), 1.24 (95%CI: 0.51-3.07), 0.98 (95%CI: 0.55-1.72), 2.39 (95%CI: 0.57-18.45), 1.21 (95%CI: 0.43-3.39), 1.22 (95%CI: 0.69-2.11), 0.80 (95%CI: 0.22-2.66), and 1.32 (95%CI: 0.47-3.83) for amlodipine, azithromycin, doxycycline, pemirolast, perindopril, propranolol, roxithromycin, and telmisartan, respectively. A total of 5 studies (1284 patients) reported adverse events associated with drug therapy. There was no significant difference in the risk of adverse events with doxycycline, pimirolast, and telmisartan compared with placebo, and the pooled RR values were 1.06 (95%CI: 0.95-1.18), 1.01 (95%CI: 0.88-1.17), and 1.07 (95%CI: 0.85-1.37), respectively.

Conclusion

This NMA demonstrated that no drugs have a definitive therapeutic effect on AAA, and further prospective RCTs are still required.

Key words: Abdominal aortic aneurysm, Rupture, Pharmacological therapy, Network meta-analysis

Ruihua Li, Wei Zhou, Yang Liu. Pharmacological treatment of abdominal aortic aneurysm: a systematic review and network Meta-analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(12): 1277-1284.

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Figures/Tables 8

References 60

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研究	地区	干预措施	例（男/女）	年龄（岁）^a	腹主动脉瘤直径（mm）^a	吸烟/不吸烟（例）	平均舒张压（mmHg）^a	腹主动脉瘤事件（例）	所有预期不良事件（例）
Baxter^[18]	美国	安慰剂	125（108/17）	70.9±7.3	44.0（40.0~47.0）	43/82	NR	9	111
Baxter^[18]	美国	多西环素	129（111/18）	71.0±7.5	43.0（40.0~46.0）	44/85	NR	13	121
Mosorin^[19]	芬兰	安慰剂	15（13/2）	68.1 （64.1~73.0）	35.0（31.0~40.0）	NR	NR	3	NR
Mosorin^[19]	芬兰	多西环素	17（16/1）	68.6 （64.4~71.3）	31.0（27.5~38.5）	NR	NR	2	NR
Meijer^[20]	荷兰	安慰剂	142（114/28）	70.0±8.0	43.1±5.5	52/90	85.0±10.0	24	21
Meijer^[20]	荷兰	多西环素	144（120/24）	70.0±7.0	43.0±5.5	48/96	83.0±9.0	21	28
Vammen^[21]	丹麦	安慰剂	49（NR）	73.0±3.7	36.9±5.1	29/20	85.5±12.8	7	NR
Vammen^[21]	丹麦	罗红霉素	43（NR）	72.0±3.7	38.1±5.7	26/17	86.5±13.1	5	NR
Karlsson^[22]	加拿大	安慰剂	107（79/28）	71.0（67.0~76.0）	40.0（36.0~44.0）	40/65	NR	13	8
Karlsson^[22]	加拿大	阿奇霉素	106（84/22）	71.0（67.0~74.0）	40.0（37.0~44.0）	40/66	NR	16	13
Sillesen^[23]	欧洲	安慰剂	84（77/7）	70.7±5.7	44.0±2.8	34/50	NR	2	68
Sillesen^[23]	欧洲	吡嘧司特	242（210/32）	70.8±6.3	44.2±2.8	96/146	NR	12	196
Lindholt^[24]	丹麦	安慰剂	24（NR）	69.6±4.7	34.7±5.3	15/9	93.3±10.4	5	NR
Lindholt^[24]	丹麦	普萘洛尔	30（NR）	68.7±6.4	34.6±5.6	21/9	98.0±10.6	7	NR
Investigators^[25]	加拿大	安慰剂	282（233/49）	68.7（61.1~76.3）	39.0（34.0~45.0）	NR	82.0（63.0~101.0）	58	NR
Investigators^[25]	加拿大	普萘洛尔	266（227/39）	69.1（61.0~77.2）	39.0（34.0~45.0）	NR	83.0（73.0~93.0）	73	NR
Golledge^[26]	澳大利亚	安慰剂	101（91/10）	73.8±7.8	43.1±5.2	27/74	78.0±9.0	8	58
Golledge^[26]	澳大利亚	替米沙坦	106（92/14）	73.2±8.1	43.3±5.8	23/83	80.0±10.0	11	65
Bicknell^[27]	英国	安慰剂	79（74/5）	70.7±7.5	41.0±7.0	17/62	77.9±7.6	9	NR
		培哚普利	73（71/2）	71.6±6.9	41.0±7.0	21/52	76.7±8.0	10	NR
		氨氯地平	72（66/6）	71.5±6.7	40.0±7.0	18/54	78.0±7.0	7	NR

研究	地区	干预措施	例（男/女）	年龄（岁）^a	腹主动脉瘤直径（mm）^a	吸烟/不吸烟（例）	平均舒张压（mmHg）^a	腹主动脉瘤事件（例）	所有预期不良事件（例）
Baxter^[18]	美国	安慰剂	125（108/17）	70.9±7.3	44.0（40.0~47.0）	43/82	NR	9	111
Baxter^[18]	美国	多西环素	129（111/18）	71.0±7.5	43.0（40.0~46.0）	44/85	NR	13	121
Mosorin^[19]	芬兰	安慰剂	15（13/2）	68.1 （64.1~73.0）	35.0（31.0~40.0）	NR	NR	3	NR
Mosorin^[19]	芬兰	多西环素	17（16/1）	68.6 （64.4~71.3）	31.0（27.5~38.5）	NR	NR	2	NR
Meijer^[20]	荷兰	安慰剂	142（114/28）	70.0±8.0	43.1±5.5	52/90	85.0±10.0	24	21
Meijer^[20]	荷兰	多西环素	144（120/24）	70.0±7.0	43.0±5.5	48/96	83.0±9.0	21	28
Vammen^[21]	丹麦	安慰剂	49（NR）	73.0±3.7	36.9±5.1	29/20	85.5±12.8	7	NR
Vammen^[21]	丹麦	罗红霉素	43（NR）	72.0±3.7	38.1±5.7	26/17	86.5±13.1	5	NR
Karlsson^[22]	加拿大	安慰剂	107（79/28）	71.0（67.0~76.0）	40.0（36.0~44.0）	40/65	NR	13	8
Karlsson^[22]	加拿大	阿奇霉素	106（84/22）	71.0（67.0~74.0）	40.0（37.0~44.0）	40/66	NR	16	13
Sillesen^[23]	欧洲	安慰剂	84（77/7）	70.7±5.7	44.0±2.8	34/50	NR	2	68
Sillesen^[23]	欧洲	吡嘧司特	242（210/32）	70.8±6.3	44.2±2.8	96/146	NR	12	196
Lindholt^[24]	丹麦	安慰剂	24（NR）	69.6±4.7	34.7±5.3	15/9	93.3±10.4	5	NR
Lindholt^[24]	丹麦	普萘洛尔	30（NR）	68.7±6.4	34.6±5.6	21/9	98.0±10.6	7	NR
Investigators^[25]	加拿大	安慰剂	282（233/49）	68.7（61.1~76.3）	39.0（34.0~45.0）	NR	82.0（63.0~101.0）	58	NR
Investigators^[25]	加拿大	普萘洛尔	266（227/39）	69.1（61.0~77.2）	39.0（34.0~45.0）	NR	83.0（73.0~93.0）	73	NR
Golledge^[26]	澳大利亚	安慰剂	101（91/10）	73.8±7.8	43.1±5.2	27/74	78.0±9.0	8	58
Golledge^[26]	澳大利亚	替米沙坦	106（92/14）	73.2±8.1	43.3±5.8	23/83	80.0±10.0	11	65
Bicknell^[27]	英国	安慰剂	79（74/5）	70.7±7.5	41.0±7.0	17/62	77.9±7.6	9	NR
		培哚普利	73（71/2）	71.6±6.9	41.0±7.0	21/52	76.7±8.0	10	NR
		氨氯地平	72（66/6）	71.5±6.7	40.0±7.0	18/54	78.0±7.0	7	NR

氨氯地平
0.69（0.16~2.80）	阿奇霉素
0.87（0.25~3.00）	1.27（0.44~3.77）	多西环素
0.35（0.04~2.18）	0.51（0.06~2.81）	0.40（0.05~1.93）	吡嘧司特
0.72（0.24~2.06）	1.03（0.26~4.08）	0.81（0.25~2.63）	2.03（0.33~19.01）	培哚普利
0.85（0.28~2.58）	1.24（0.51~3.07）	0.98（0.55~1.72）	2.39（0.57~18.45）	1.21（0.43~3.39）	安慰剂
0.70（0.20~2.42）	1.02（0.36~2.94）	0.80（0.37~1.79）	1.97（0.42~16.19）	0.99（0.31~3.21）	0.82（0.47~1.45）	普萘洛尔
1.07（0.21~5.58）	1.57（0.35~7.16）	1.22（0.32~5.01）	3.06（0.46~31.67）	1.51（0.31~7.78）	1.25（0.38~4.51）	1.53（0.4~6.08）	罗红霉素
0.65（0.14~2.94）	0.94（0.23~3.84）	0.74(0.22~2.38）	1.86（0.3~17.28）	0.91（0.2~3.95）	0.76（0.26~2.14）	0.92（0.28~2.92）	0.60（0.12~3.01）	替米沙坦

氨氯地平
0.69（0.16~2.80）	阿奇霉素
0.87（0.25~3.00）	1.27（0.44~3.77）	多西环素
0.35（0.04~2.18）	0.51（0.06~2.81）	0.40（0.05~1.93）	吡嘧司特
0.72（0.24~2.06）	1.03（0.26~4.08）	0.81（0.25~2.63）	2.03（0.33~19.01）	培哚普利
0.85（0.28~2.58）	1.24（0.51~3.07）	0.98（0.55~1.72）	2.39（0.57~18.45）	1.21（0.43~3.39）	安慰剂
0.70（0.20~2.42）	1.02（0.36~2.94）	0.80（0.37~1.79）	1.97（0.42~16.19）	0.99（0.31~3.21）	0.82（0.47~1.45）	普萘洛尔
1.07（0.21~5.58）	1.57（0.35~7.16）	1.22（0.32~5.01）	3.06（0.46~31.67）	1.51（0.31~7.78）	1.25（0.38~4.51）	1.53（0.4~6.08）	罗红霉素
0.65（0.14~2.94）	0.94（0.23~3.84）	0.74(0.22~2.38）	1.86（0.3~17.28）	0.91（0.2~3.95）	0.76（0.26~2.14）	0.92（0.28~2.92）	0.60（0.12~3.01）	替米沙坦

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