Network Meta-analysis Of Efficacy And Safety Of Treatment For Systemic Lupus Erythematosus

Objective:We aimed to evaluate and compare the effects and safety of glucocorticoid,antimalarial drug,immunosuppressant,Chinese herb and biological agent used alone or in combination for systemic lupus erythematosus by using network Meta-analysis.Methods:We searched the Cochrane Library,Pubmed,Embase,VIP Chinese Journal Datebase,Wanfang datebase and CNKI datebase.Retrieval time for each datebase was up to December 31,2021.We screened literature according to pre-established inclusion and exclusion criteria,Intervention measures are limited to glucocorticoid,antimalarial drugs,immunosuppressants,Chinese herb and biological agents alone or in combination.and assessed the risk of the included studies.R4.1.3 and ADDIS were used for statistical analysis.The treatments compared with each other and ranked according to the effects on the total effective rate,complement C3,SLEDAI score and adverse reaction rate by network Meta-analysis.Results:1.Finally,a total of 2344 SLE patients were included in 30 literatures.All 30 literatures mentioned the age of the researchers,and only one literature did not mention the course of treatment,the allocation concealment method and blind method.2.A total of 24 literatures reported the total effective rate.The order of total effective rate from high to low probability is: glucocorticoid + antimalarial drug +Chinese herb,glucocorticoid + Chinese herb,antimalarial drug + Chinese herb,glucocorticoid + immunosuppressant + Chinese herb,glucocorticoid + antimalarial drug,glucocorticoid,glucocorticoid + immunosuppressant + antimalarial drug,glucocorticoid + immunosuppressant + biological agent,glucocorticoid + biological agent,glucocorticoid + immunosuppressant.3.A total of 22 literatures reported complement C3.In terms of improving complement C3,the order of probability from high to low is glucocorticoid +antimalarial drug + Chinese herb,glucocorticoid + Chinese herb,glucocorticoid +antimalarial drug,glucocorticoid + immunosuppressant + Chinese herb,glucocorticoid+ immunosuppressant + antimalarial drug,glucocorticoid,glucocorticoid +immunosuppressant.4.A total of 20 literatures reported SLEDAI scores.In terms of reducing SLEDAI score,the order from high to low probability is glucocorticoid + biological agent,antimalarial drug + Chinese herb,glucocorticoid + antimalarial drug + Chinese herb,glucocorticoid + immunosuppressant + biological agent,glucocorticoid + Chinese herb,glucocorticoid + immunosuppressant + antimalarial drug,glucocorticoid + antimalarial drug,glucocorticoid,glucocorticoid + immunosuppressant.5.A total of 14 literatures reported adverse reactions.The probability ranking of adverse reaction rate from high to low is: glucocorticoid + antimalarial drug,glucocorticoid + immunosuppressant,glucocorticoid + antimalarial drug + Chinese herb,glucocorticoid,glucocorticoid + immunosuppressant + biological agent,glucocorticoid + biological agent,glucocorticoid + immunosuppressant + antimalarial drug,glucocorticoid + Chinese herb.Conclusion:In terms of total effective rate,the schemes of glucocorticoid + antimalarial drugs+ Chinese herb and glucocorticoid + Chinese herb have the best therapeutic effect.glucocorticoid + antimalarial drugs + Chinese herb and glucocorticoid + Chinese herb have the best effect on improving complement C3.glucocorticoid + biological agents had the best effect in reducing SLEDAI score.In terms of adverse reactions,glucocorticoid + Chinese herb has the best safety.