无合并哮喘的过敏性鼻炎的症状性干预：剂量分层网络荟萃分析。

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中文摘要

背景： 过敏性鼻炎（AR）是一种全球负担沉重的常见慢性疾病。尽管存在众多治疗干预措施，但其相对疗效和安全性仍不明确。本研究的目的是通过系统评价和剂量分层网络荟萃分析（NMA），评估无合并哮喘的季节性和常年性AR的症状性干预措施。
方法： 我们系统检索了Web of Science、Cochrane Library、Scopus、PubMed和Embase中的随机对照试验。排除了评估免疫治疗、替代医学或主要纳入合并哮喘患者的研究。采用频率学随机效应NMA在类别和剂量特异性水平上比较干预措施。主要结局为总鼻症状评分（TNSS）、总眼部症状评分、生活质量和不良事件。使用累积排名曲线下面积（SUCRA）得出治疗排名，并使用网络荟萃分析推荐分级的评估、制定与评价（GRADE）对TNSS结局的证据确定性进行评估。该方案已在PROSPERO注册（CRD42024507281）。评估了全局和局部不一致性。
结果： 从36,669条记录中，纳入了175项随机对照试验（RCT），涵盖超过90,000名参与者。在网络荟萃分析中，治疗排名因结局而异，没有一种方案始终优于其他方案；观察到的异质性和几个网络中的显著不一致性妨碍了就相对有效性得出确切结论。在几个药物类别中观察到效应量的类内差异。某些较高剂量的鼻内皮质类固醇单药治疗在SUCRA分析中位列排名靠前的干预措施。尽管如此，鉴于某些网络中存在的显著异质性和不一致性，这些排名应谨慎解读。在大多数比较中，TNSS结局的证据确定性为中等至极低。
讨论： 尽管进行了敏感性分析，但在几个比较中仍存在显著的统计不一致性，尤其是季节性AR的TNSS。该分析仅限于无合并哮喘的患者。总体而言，无法确定普遍优越的方案。鉴于剩余的异质性和不一致性，这些发现应被视为探索性和产生假设性的，而非相对有效性的确定性证据。这些发现提出了治疗选择可能受益于个体化方法的可能性，但仍需验证性研究。
注册： PROSPERO CRD42024507281。

英文摘要

BACKGROUND: Allergic rhinitis (AR) is a prevalent chronic condition with a substantial global burden. Although numerous therapeutic interventions exist, their comparative efficacy and safety remain unclear. The objective was to evaluate symptomatic interventions for seasonal and perennial AR without comorbid asthma via a systematic review and dose-stratified network meta-analysis (NMA).
METHODS: We systematically searched Web of Science, Cochrane Library, Scopus, PubMed, and Embase for randomized controlled trials. Studies evaluating immunotherapy, alternative medicine, or primarily enrolling patients with comorbid asthma were excluded. A frequentist random-effects NMA compared interventions at class and dose-specific levels. Primary outcomes were total nasal symptom score (TNSS), total ocular symptom score, quality of life, and adverse events. Treatment rankings were derived using the surface under the cumulative ranking curve (SUCRA), and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation for Network Meta-Analysis for the TNSS outcome. The protocol was registered in PROSPERO (CRD42024507281). Global and local inconsistencies were evaluated.
RESULTS: From 36,669 records, 175 randomized controlled trials (RCTs) encompassing over 90,000 participants were included. In the network meta-analysis, treatment rankings varied across outcomes, and no single regimen consistently outperformed others; the observed heterogeneity and significant inconsistency in several networks precluded firm conclusions regarding comparative effectiveness. Intra-class differences in effect sizes were observed across several drug classes. Certain higher-dose intranasal corticosteroid monotherapies appeared among the top-ranked interventions in SUCRA analyses. Still, these rankings should be interpreted cautiously given the substantial heterogeneity and inconsistency in some networks. The certainty of evidence for the TNSS outcome was moderate to very low in most comparisons.
DISCUSSION: Despite sensitivity analyses, significant statistical incoherence persisted in several comparisons, particularly for TNSS in seasonal AR. The analysis was limited to patients without comorbid asthma. Overall, no universally superior regimen could be identified. Given the remaining heterogeneity and inconsistency, the findings should be regarded as exploratory and hypothesis-generating rather than as definitive evidence of comparative effectiveness. These findings raise the possibility that treatment selection may benefit from an individualized approach, although confirmatory studies are needed.
REGISTRATION: PROSPERO CRD42024507281.