Meta-analysis of the Efficacy and Safety of Different Administration Routes of Bevacizumab in the Treatment of Malignant Pleural Effusion / 中国药房

ABSTRACT

OBJECTIVE：To evaluate the efficacy and s afety of different administration routes of bevacizumab in the treatment of malignant pleural effusion （MPE），and to provide evidence-based reference for rational use of drugs in clinic. METHODS ： Retrieved from Cochrane L ibrary，PubMed，Embase，VIP，CNKI，Wanfang database and CBM ，clinical studies were collected ， about bevacizumab combined with or without chemotherap eutic drugs （trial group ）versus chemotherap eutic drugs （control group ） in the treatment of MPE under different administration routes. After literature screening and data extraction ，the quality of RCTs was evaluated by using bias risk evaluation tool recommended by Cochrane Systematic Evaluator Manual 5.3. Newcastle-Ottawa scale was used to evaluate the quality of the retrospective study. Meta-analysis was performed by using Rev Man 5.3 software， network Meta-analysis was performed by using Stata 13.0 software and intervention measures were ranked by using R 3.6.1 software. RESULTS ：A total of 29 studies were included ，involving 21 RCTs and 8 retrospective studies ，including 2 254 patients. The studies involved 5 intervention measures ，such as bevacizumab+chemotherap eutic drugs （thoracic perfusion ），bevacizumab+ chemotherapeutic drugs （ivgtt），bevacizumab（thoracic perfusion ），chemotherapeutic drugs （thoracic perfusion ），chemotherapeutic drugs（ivgtt）. Network Meta-analysis showed there was no statistical significance in bevacizumab+chemotherap eutic drugs （thoracic perfusion）and bevacizumab+chemotherap eutic drugs （ivgtt）[OR＝0.81，95％CI（0.13，4.60），P＞0.05]，chemotherapeutic drugs （thoracic perfusion ）and chemo therapeutic drugs （ivgtt）[OR＝ 0.47， 95％ CI （0.07，3.10）， P＞0.05]， bevacizumab + Z19SCHX202） chemotherapeutic drugs （ivgtt） and chemotherap eutic drugs （ivgtt） [OR＝0.56，95％ CI（0.27，1.20），P＞0.05]. Total 、 response rate of bevacizumab + chemotherap eutic drugs （thoracic perfusion ） [OR＝3.10，95％ CI（2.10，4.50），P＜ 0.05]，bevacizumab（thoracic perfusion ）[OR＝1.90，95％CI （0.99，3.90），P＜0.05] were significantly higher than chemotherapeutic drugs （thoracic perfusion ）. Network Meta-analysis ranking showed that bevacizumab + chemotherapeutic drugs （ivgtt）＞ bevacizumab + chemotherapeutic drugs （thoracic perfusion ）＞ bevacizumab（thoracic perfusion ）＞chemotherapeutic drugs （ivgtt）＞chemotherapeutic drugs （thoracic perfusion ）. The incidence of elevated blood pressure [RR= 2.64，95％CI（1.56，4.43），P＝0.000 3] and proteinuria [RR ＝3.24，95％CI（1.79，5.86），P＝0.000 1] in trial group were significantly higher than control group. There was no statistical significance in the incidence of granulo- cytopenia [RR ＝0.94，95％CI（0.81，1.09），P＝0.41] or nausea and vomiting [RR ＝0.87，95％CI（0.73，1.03），P＝0.10] between 2 groups. Compared with chemotherapy alone ，bevacizumab combined chemotherapy could not prolong the total survival time of patients，but can improve the progression-free survival time. CONCLUSIONS ：Bevacizumab combined with chemotherapy can improve the efficacy of MPE patients ，but thoracic perfusion can increase the risk of proteinuria and elevated blood pressure.